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Clustering of unhealthy behaviours over time Implications for policy and practice

People’s lifestyles – whether they smoke, how much they drink, what they eat, whether they take regular exercise – are widely recognised as affecting their health and risk of dying young.

In 2002, the World Health Organization revealed that in the world’s most highly industrialised countries in North America, Europe and Asia, alcohol and smoking, low consumption of fruit and vegetables and lack of physical activity were associated with about 29 per cent of the disease burden, estimated by disability-adjusted life years (DALYs) lost (World Health Organization 2002). These behaviours are also linked to high cholesterol, obesity and overweight, which were associated with a further 15 per cent of the disease burden in these countries.

Close to half of the burden of illness in developed countries is therefore associated with the four main unhealthy behaviours: smoking, excessive consumption of alcohol, poor diet and low levels of physical activity.

The collective term for these behaviours is the subject of much debate, with professionals from different fields preferring different terminology, each having a view about what is pejorative and what is not. Phrases used range from ‘unhealthy behaviours’ and ‘poor health behaviours’, through to ‘multiple lifestyle risks’. We use these terms interchangeably in this paper.

It is well known that each of these lifestyle risk factors is unequally distributed in the population and that these behaviours are differentially associated with income, educational achievement and social class. There has been an increasing amount of research into how these lifestyle risks co-occur or cluster in the population, but the logical next question – how have these patterns of multiple lifestyle risk been evolving over time? – has not been examined to our knowledge in England. The core purpose of this paper is to answer that question in the context of the English population and to set out the implications for public health policy and practice.