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Recent changes in health behavioursof young women and the new public health systemDavid BuckThe King’s FundUs Girls! Get in the Know! What girls, think, feel and do!University of Warwick, 15th January 2013
Changes in health behaviours: What’s been happening?
For adults, some encouraging news on trendsin behaviours in recent yearsSource: Gregory et al (2012) Health policy under the coalition government: A mid-term assessment. TheKing’s Fund. Available from, http://www.kingsfund.org.uk/publications/health-policy-under-coalition-government
Even more encouraging for young women?Source: King’s Fund analysis, derived from Health Survey for England adult trend tables, fromhttp://www.ic.nhs.uk/catalogue/PUB09302/HSE2011-Adult-trend-tbls.xlsNote: Each series has its own caveats and qualifications, see source for details. Data presented here has been chosenfor reasonable comparability over time.
But we all know that most health behaviours are not experienced in isolation...
..this matters a lot. Having many poorbehaviours has an increasing impact on health..Source: EPIC-Norfolk cancer studies
Government policy has focussed onbehaviours in isolation... March 2011 October 2011 March 2012
...is this enough? We looked at the HealthSurvey 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?
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
Within this there are 16 specific riskcombinations, poor diet and exercise dominant Prevalence of combinations of multiple lifestyle risk factors in 2003 by sex 35 Men 30 women 25 20 15 10 A n p u d e a g v c s r t j l 5 0 d P D D D D d P p d p P s d p P p d P S D S D D F D S S F f d s s P p d P p s s P p F S f F F S f F f f F S F S f f s s Combinations of lifestyle risk factors Note: S=Smoking; D=Drinking; F= Fruit&Vegetable; P=Physical activity; Capital letters= presence of risk factor
Significant changes over time in some of thesecombinations Change in prevalence of combinations of multiple lifestyle risk factors between 2003 and 2008 by sex -2 8 0 4.0 3.0 2.0 * 1.0 ** * * ** 0.0 ** * ** * ** -1.0 Men -2.0 Women -3.0 w o b h p n -4.0 P 3 0 2 e a g v c r t l i D D d P d p d P p D D P D D S S p d p d s P P d P p d P p s s D D S S F F f F S F F S F f f f f p s s P s s F S F S f f Combinations of lifestyle risk factors Note: S=Smoking; D=Drinking; F= Fruit&Vegetable; P=Physical activity; Capital letters= presence of risk factor; * = significant change
..but improvements come from some sectorsof the population and not othersChange in prevalence of multiple lifestyle risk factorsbetween 2003 and 2008 for men in professionals and unskilled manual households110100 4 * 4 * 490 People with no formal80 3 * 3 * 3 qualifications 3x as70 likely to have 3 or 4 behaviours in 200360 compared to those50 2 2 with the most 24030 ..by 2008, this had20 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
Young women more likely to have veryunhealthy 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
Significant improvement by 2008, not morelikely to be very unhealthy but also not veryhealthy Note: S=Smoking; D=Drinking; F= Fruit&Vegetable; P=Physical activity; Capital letters= presence of risk factor; * = significant change
Overall, a real and significant improvement foryoung women Pattern of lifestyle risk factors 2003-08 for women 16-24Number of 2003 2008 Statisticallyrisk factors significant?4 10.5% 5.7% Y3 31.2% 23.8% Y2 39.6% 43.3% N1 14.9% 22.2% Y0 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
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?
Local authorities have new behaviour changeresponsibilities 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
..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
..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?