Behaviour and Lifestyle

Glasses of alcholic drinks

Introduction

Behaviours, such as smoking, excessive use of alcohol, the use of illicit drugs, low levels of exercise and physical activity, engaging in unsafe sex, and a poor diet all impact on physical health and mental wellbeing.  It is known that each of these lifestyle risk factors is unequally distributed in the population and that there are differences in these behaviours associated with income, educational achievement and social class.

There is compelling evidence that lifestyle risk factors tend to cluster than present in isolation.  It is estimated that in England 70% of the adult population have two or more lifestyle risk factors (King’s Fund, 2012).  Whilst there has been an overall decline in the proportion of the population with three or four unhealthy risk factors from 33% of the population in 2003, to 25% in 2008, these reductions have not been equally distributed across the population. The percentage of people with three or more lifestyle risk factors is continues to increase for people from lower socio-economic and educational groups. For instance  people with no educational qualifications were  more than five times as likely as those with higher education to have four lifestyle risk factors in 2008, compared with only three times as likely in 2003.

This variation in the distribution of lifestyle risk factors contributes to the gaps in length and quality of life between deprived and affluent groups locally and nationally. The major causes of illness and premature deaths (deaths before age 75 years) in Stockton-on-Tees are circulatory diseases, cancer, respiratory disease and digestive diseases (including liver disease).  Lifestyle risk factors such as smoking, excessive alcohol use, poor diet and physical inactivity are known to contribute to these major causes of premature deaths.

Alcohol misuse

  • Levels of alcohol-related harm in Stockton-on-Tees are broadly similar to England.  There are higher than average rates of both alcohol-related and alcohol-specific hospital admissions compared to England.
  • Alcohol misuse impacts upon physical and mental health, as well as having a detrimental effect on social cohesion, crime, violence and community safety.
  • Alcohol-related harm is a problem in Stockton-on-Tees, impacting on individuals, families and communities.

 

Illicit drug use

  • There is insufficient information in Stockton-on-Tees regarding levels of drug misuse.
  • Hospital admissions for drug-related causes are higher in more deprived areas.
  • The proportion of successful treatment outcomes for opiate users in Stockton-on-Tees is not as high as in England, but for non-opiate users they are similar to England.

 

Smoking

  • About one-in-five adults in Stockton-on-Tees is estimated to smoke, similar to England. However, smoking prevalence rises to almost one-in-two adults in some deprived wards and disadvantaged population groups.
  • In Stockton-on-Tees, 17.7% of women smoke throughout their pregnancy posing a significant health risk both to mother and unborn child.  This is 40% higher than the national average (12.7%) and lower than the North East average.
  • More than one-in-four (28%) of all deaths aged under 75 years in Stockton-on-Tees is estimated to be as a result of smoking.

 

Diet and nutrition

  • Seventy eight percent of adults in Stockton-on-Tees do not eat the recommended five daily portions of fruit and vegetables.  In England, 82% of school-aged children do not eat five portions of fruit and vegetables each day.
  • Breastfeeding rates in Stockton-on-Tees are among the lowest in England and the gap is widening.
  • There is low uptake of healthy start vitamin supplements in babies and infants.
  • Poor oral health is a robust indicator of poor nutrition and the prevalence of dental decay for children in Stockton-on-Tees is almost 50% higher than England.

 

Physical inactivity

  • Approximately 30% of the adult population of Stockton-on-Tees is inactive, with about half taking part in the recommended weekly levels of physical activity.
  • The proportion of Stockton-on-Tees school pupils doing three hours of PE per week is similar to the national average.  In Stockton-on-Tees, walking and cycling to school is more common than in England; about six in ten pupils travel actively.
  • The groups with the lowest levels of physical activity are women (particularly those aged 14-24 years); black and minority ethnic (BME) groups; those with a limiting illness/disability; and lower socioeconomic groups.

 

Obesity

  • The adult obesity rate in Stockton-on-Tees continues to be significantly higher than England and is increasing. There are inequalities in relation to the prevalence of obesity according to income, social deprivation, age, ethnicity and disability.
  • Childhood obesity doubles from 10% in reception year (age 4 to 5 years) to 20% in year 6 (aged 10 to 11 years) pupils.  Local rates are similar to England.
  • The increasing prevalence rates of obesity increases demand on health services and costs to the NHS and wider economy.

 

Sexual health

  • Stockton-on-Tees has a higher than regional average rate for syphilis and has the fourth highest HIV prevalence among North East local authorities.
  • Local teenage pregnancy rates are higher than England.
  • There is a lower uptake of termination of pregnancy (in under-18s) and a lower uptake for Long Acting Reversible Contraception (LARC) compared to England.

 

Recommendations

The recommendations below relate to the Marmot review: Fair Society, Healthy Lives, the former National Support Team recommendations for tackling Health Inequalities and latest national policy and professional guidance.

Short-term (1-2 years)
1. Commissioning and delivery of integrated public health services and programmes that address multiple lifestyle risk factors rather than taking an approach that focuses solely on single issues. Ensure that these interventions are accessible and acceptable to those at highest risk.
2. Ensure equitable access to sexual health services (prevention, early identification, awareness and treatment services) at address the high teenage pregnancy rates and sexually transmitted infections. 
3. Give all children the best start in life by tackling smoking in pregnancy, obesity in pregnancy, breast feeding and uptake of healthy start vitamins.

Medium-term (3-5 years)
1. Maximise the opportunities of creating a health promoting environment through enforcement, planning, regeneration and licence application processes.  This could include considering the restriction of planning permission for hot-food takeaways, alcohol premises (representations and cumulative impact areas), tackling availability, supply and demand for illicit drugs and tobacco.   
2. Strengthen the role of primary care, social care and voluntary and community sector (VCS) organisations in delivering lifestyle and behaviour modification programmes
3. Strengthen the use of community assets in addressing lifestyle risk factors

Long-term (over 5 years)
1. Ensure that all town planning, regeneration and transport programmes incorporate active transport routes and that future planning complements strategies to reduce alcohol related crime and violence in the town centre. 
2. Improve maternal and child health by addressing the social causes of poor health including; teenage pregnancy, educational attainment, unemployment, food poverty and maternal mental health.

Sarah Bowman
Consultant in Public Health
Stockton-on-Tees Borough Council

Leon Green
Public Health Intelligence Specialist
Tees Valley Public Health Shared Service


Reference

King’s Fund (2012). Clustering of unhealthy behaviours over time: Implications for policy and practice.