Individual behaviour can be beneficial or detrimental to health. In the latest Global Burden of Disease study, behavioural risk factors were estimated to ‘cause’ more than a quarter (28%) of all death and disability in England. 1 Poor diet (including insufficient fruit and vegetable consumption) and smoking are the most important risk factors for health nationally; harmful alcohol consumption and insufficient physical activity are also major contributors to poor health. This chapter describes all four of these ‘lifestyle’ behaviours in the context of the population of Hackney and the City of London.
It is important to remember that these individual health behaviours are rarely a free lifestyle ‘choice’, but are strongly determined by the environment in which people live their lives. For example, easy local access to cheap cigarettes and alcohol, poor access to affordable healthy food and a built environment that favours car use over walking or cycling, all act as barriers to healthier lifestyles. Social and cultural influences also play a very important role in determining how much (and what) people drink, eat, how active they are and whether they smoke.
Often, these behaviours cluster together creating multiple risk factors for poor health. National evidence suggests that a quarter of the adult (age 16+) population engage in three or more of the behavioural risk factors covered by this chapter (smoking, excess alcohol consumption, low consumption of fruit and vegetables and physical inactivity). 2 People living in more deprived circumstances are more likely to be exposed to multiple risk factors, which acts to further widen social inequalities in health.
Growing recognition of the complex interaction of various external influences on individual behaviour has led to a rise in prominence in recent years of ‘behavioural insight’ or behaviour change theory. Behavioural insight uses information that is known about the drivers of behaviour in a particular population to design appropriate interventions to ‘nudge’ people away from undesirable (or unhealthy) behaviours towards more desirable ones. There are many theories of behaviour change; one that is commonly used in the UK is a theory developed by scientists at the Cabinet Office, which describes influences on individual behaviour using the mnemonic ‘MINDSPACE’ – see Table 1 below.
Table 1: MINDSPACE – influences on individual behaviour 3
|Messenger||We are heavily influenced by who communicates information|
|Incentives||Our responses to incentives are shaped by predictable mental shortcuts (e.g. we dislike losses more than we like gains)|
|Norms||We are strongly influenced by what others do|
|Defaults||We ‘go with the flow’ of pre-set options|
|Salience||Our attention is drawn to what is novel and seems relevant to us|
|Priming||Our acts are often influenced by sub-conscious cues|
|Affect||Our emotional associations can powerfully shape our actions|
|Commitments||We seek to be consistent with our public promises, and reciprocate acts|
|Ego||We act in ways that make us feel better about ourselves|
Each section of this chapter covers a different behaviour, but uses the same clear and consistent format to present the evidence for each, content is framed around the headings below.
A summary of key findings from the chapter can be found in the following document:
The chapter is structured into four main sections (each covering a different topic) listed below.
- J. N. Newton, A. D. Briggs, C. J. L. Murray, D. Dicker, K. J. Foreman and H. Wang, “Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013,” The Lancet, no. http://dx.doi.org/10.1016/S0140-6736(15)00195-6, September 2015.
- D. Buck and F. Frosini, “Clustering of health behaviours over time: implications for policy and practice,” 2012. [Online]. Available: https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/clustering-of-unhealthy-behaviours-over-time-aug-2012.pdf.
- P. Dolan, M. Hallsworth, D. Halpern, D. King and I. Vlaev, “MINDSPACE: influencing behaviour through public policy,” January 2010. [Online]. Available: http://www.instituteforgovernment.org.uk/sites/default/files/publications/MINDSPACE.pdf.