The good news is that government interventions have had a positive impact on healthy living. The bad news is that they're mainly helping the better-off
Some might say that the biggest short-term impact of the Olympics has been the intense attention currently being given to its legacy. Hoping to build on the bounce of interest in physical activity, new initiatives have already been launched in London, Wales and elsewhere. Sustaining this interest may prove a significant challenge.
One way forward will be to build on any short-term positive effects as local government takes on the mantle of behaviour change from the NHS - and an annual budget of over £2bn. That will, in turn, depend on a having a greater understanding of how local populations are behaving and how this is changing over time.
Central government has been championing ‘nudge’ and the public health ‘responsibility deal’ and has released a raft of strategies on individual behaviours. But for local government, a greater understanding of how these are actually distributed amongst their communities will be key to improving health outcomes.
The King's Fund's new report outlines what’s been happening to clusters of health behaviours – such as smoking, and not meeting guidelines on alcohol intake, fruit and vegetable consumption and physical activity - over time. We looked at two waves of the national Health Survey for England between 2003 and 2008 and uncovered some welcome news.
The proportion of the population who had three or four of these unhealthy behaviours fell significantly from around one in three adults to around one in four. This questions the idea that in developed countries such as our own, ‘lifestyles of affluence’ have of necessity to be increasingly damaging and lead to ever more chronic disease and shorter lives.
Within generally richer populations it is clearly possible to see improvements in lifestyles and a reduction in mortality risk. There is however, an unsurprising fly in the ointment to this generally positive message.
Most of the improvements we have seen come from people in high socio-economic groups and with higher education levels. Relative inequalities have therefore increased. For example, the chances of someone with no qualifications having four unhealthy behaviours compared to someone who has benefited from higher education increased from three-fold to five-fold over the period.
This has been happening under our very noses but we haven’t noticed it because the focus of much government strategy has been to look at individual behaviours, one at a time. We believe that local authorities and those on health and wellbeing boards are much better placed, with their local knowledge and expertise, to both understand and act to improve clusters of health behaviours.
This will be crucial in developing successful, targeted public health responses and joint health and wellbeing strategies. But it will also need support from Public Health England and NICE in understanding - and then sharing - the evidence on how to sustain multiple behaviour change, and on what methods are cost-effective, especially in poorer and less educated groups.
Tackling unhealthy lifestyles is an Olympic-sized challenge but the new system, with the role of local authorities and health and wellbeing boards at its heart, is well-placed to take this on.
David Buck is a senior fellow at The King's Fund, and a former head of health inequalities at the Department of Health
