Presentation by David Buck of the King's Fund

1. Recent changes in health behaviours
of young women and the new public
health system
David Buck
The King’s Fund
Us Girls! Get in the Know! What girls, think, feel and do!
University of Warwick, 15th January 2013

2. Changes in health behaviours: What’s been
happening?

3. For adults, some encouraging news on trends
in behaviours in recent years
Source: Gregory et al (2012) Health policy under the coalition government: A mid-term assessment. The
King’s Fund. Available from, http://www.kingsfund.org.uk/publications/health-policy-under-coalition-
government

4. Even more encouraging for young women?
Source: King’s Fund analysis, derived from Health Survey for England adult trend tables, from
http://www.ic.nhs.uk/catalogue/PUB09302/HSE2011-Adult-trend-tbls.xls
Note: Each series has its own caveats and qualifications, see source for details. Data presented here has been chosen
for reasonable comparability over time.

5. But we all know that most health behaviours
are not experienced in isolation...

6. ..this matters a lot. Having many poor
behaviours has an increasing impact on health..
Source: EPIC-Norfolk cancer studies

7. So, what’s been happening?

8. Government policy has focussed on
behaviours in isolation...
March 2011 October 2011 March 2012

9. ...is this enough? We looked at the Health
Survey for England to find out..
What has been happening over time?
– As a population, do more or fewer of us smoke and drink above limits
and exercise below guidelines and eat unhealthily?
– And if so, are we all doing so equally, or are certain groups more likely
to be doing so than others?
What might this mean for policy?
– How government decides to focus its policies
– How government designs payments to the NHS, and other elements of
the health and public health system
What might this mean for practice?
– Does is mean we would be more effective if we focussed on people
with “clusters” of behaviour, rather than those with single behaviours?
– What about local health and wellbeing strategies?

10. We found real improvements over time
Consistent with movements “down ladder”
– Shedding 3 and 4 behaviours, maintaining 1 and 2
– Overall about a 20% drop in 3+ behaviours for men and women
– But, 70% of the population still have at least 2 behaviours

11. Within this there are 16 specific risk
combinations, poor diet and exercise dominant
Prevalence of combinations of multiple lifestyle risk factors in 2003 by sex
35
Men
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women
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Combinations of lifestyle risk factors
Note: S=Smoking; D=Drinking; F= Fruit&Vegetable; P=Physical activity; Capital letters= presence of risk factor

12. Significant changes over time in some of these
combinations
Change in prevalence of combinations of multiple lifestyle risk factors
between 2003 and 2008 by sex
-2
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Combinations of lifestyle risk factors
Note: S=Smoking; D=Drinking; F= Fruit&Vegetable; P=Physical activity; Capital letters= presence of risk factor;
* = significant change

13. ..but improvements come from some sectors
of the population and not others
Change in prevalence of multiple lifestyle risk factors
between 2003 and 2008 for men in professionals and
unskilled manual households
110
100
4 * 4 * 4
90 People with no formal
80 3 * 3 * 3 qualifications 3x as
70
likely to have 3 or 4
behaviours in 2003
60
compared to those
50
2 2
with the most
2
40
30 ..by 2008, this had
20 risen to 5x as likely.
* 1 *
10 1 1 *
0 0 * 0 * 0
2003 - All pop 2008 - All pop 2003 - 2008 - 2003- 2008
Professionals Professionals Unskilled Unskilled

14. What about girls?

15. Young women more likely to have very
unhealthy and very healthy behaviour in 2003
Note: S=Smoking; D=Drinking; F= Fruit&Vegetable; P=Physical activity; Capital letters= presence of risk factor;
* = significant change

16. Significant improvement by 2008, not more
likely to be very unhealthy but also not very
healthy
Note: S=Smoking; D=Drinking; F= Fruit&Vegetable; P=Physical activity; Capital letters= presence of risk factor;
* = significant change

17. Overall, a real and significant improvement for
young women
Pattern of lifestyle risk factors 2003-08 for women 16-24
Number of 2003 2008 Statistically
risk factors significant?
4 10.5% 5.7% Y
3 31.2% 23.8% Y
2 39.6% 43.3% N
1 14.9% 22.2% Y
0 3.8% 4.9% N
... but 95% of young women will have at least one risk factor and almost
3 in 4 will have 2 or more

18. So what for policy and practice?

19. Findings have implications for policy...
Keep doing what seems to be working
– For most of population, things look like “they are working”
– Don’t forget what you already know e.g. Healthy Foundations
“Improving the health of the poorest fastest”
– Relook at relationship between PH and inequalities policy
– A multi-behaviours approach, with a socio-economic focus?
– Public health ambitions – how targeted are they?
Levers
– What does this mean for “Making Every Contact Count”?
– How should levers and incentives be designed to take into
account lifestyle clustering?

20. Local authorities have new behaviour change
responsibilities
New local authority role
– Responsibility for health improvement including tobacco control,
alcohol, obesity and physical activity
– Can call on a wide diversity of “channels” for behaviours change, from
NHS staff to council, to health trainers and health champions
..not forgetting the NHS
– Making Every Contact Counts policy
– Public health outcomes inc behaviour change in QOF
– Enhanced potential for influence of NICE
– New inequalities duties on the NHS
But...
– often easy to see behaviours in isolation from one another
– and from people’s individual & economic & social environment

21. ..this sets the context for their new role
Be aware
– 70% of adults seen by services will not be adhering to
government guidelines on 2+ unhealthy behaviours
– ...but many will have had a recent record of success in other
areas of behaviour change, can be built on
– Health trainer evidence suggests “the visible” often drives first
contact, but the real issues & desire to change are often in other
areas
– Every relationship, not every contact that counts

22. ..and for your practice?
Many of the young women you work with will have
combinations or clusters of unhealthy behaviours, even
though generally things seem to be improving over time
Q: Do you feel you have a better understanding of healthy
and unhealthy behaviours, and the concept of clustering?
Q: Can you see the opportunity and the reason to engage
with the health and local authority sectors?
Q: Do you know what your next step could be?