The Long Term Costs of Lifestyle Risks. Pathways to Change: A Case Study in the UK

2. Prevention: Limited by Inequality of Response?

A second main challenge is inherent in the fact that the incidence of poor levels of physical inactivity is distributed unevenly across the population. Low family income is particularly associated with multiple unhealthy behaviours. People with low incomes eat less fruit and vegetables and exercise less than people with higher incomes, meaning health problems such as obesity are strongly linked to socio-economic status. Poorer areas, for instance, may lack shops selling healthy food at competitive prices, making it more difficult for lower income families to have a healthy, balanced diet. People in lower socio-economic groups are also 50% more likely to smoke. People on the highest incomes are, in contrast, most likely to participate in sport18.

Part of the complexity in identifying the causes of poor health causes is the tendency for negative lifestyle traits to be highly correlated. Many individuals who are overweight also smoke, drink too much and do not exercise regularly, and as a result of these behaviours are more likely to be depressed and out of work. Research also shows that smokers frequently have lower levels of physical activity, lower consumption of fruit and vegetables and higher alcohol consumption than non-smokers or ex-smokers19.

There is also evidence of a geographic divide in health, with poorer health in the north of England compared to the south. With the exception of London, levels of obesity are generally lower in the south of England20. Reflecting this geographic divide in health outcomes most of the Spearhead Group Primary Care Trusts (PCTs), set up in order to address growing health inequalities, are in the north of England.

Poor educational outcomes also have an effect on health, with many people from lower socio-economic groups less likely to be well informed on why and how to make healthy choices.

Table 1: Correlation between different behaviours by socio-economic group
Source: Statistics on Alcohol: England, 2008 The NHS Health and Social Care Information Centre; Statistics on Smoking: England, 2008 The Health and Social Care Information Centre; Statistics on obesity, physical activity and diet: England, February 2009; The NHS Social Care Information Centre, Lifestyles statistics.

3. The Cost of the Workless Unfit

The outcomes of unhealthy living are a major source of costs, for the NHS and the economy as a whole. If effective action is not taken on both treating and preventing unhealthy behaviours the financial cost to the NHS will continue to grow and the NHS may become financially unsustainable21.

Physiotherapy provision is a cause for concern given the prevalence of back pain and musculoskeletal problems among the British workforce. Back pain accounts for 47% of non-manual absence and 67% of short-term absence, as well as 45% of non-manual and 60% of manual long-term absence. Other musculoskeletal problems account for 48% and 51% of long term absences22. The Chartered Institute of Physiotherapy has reported significant increases in waiting times for physiotherapy with musculoskeletal patients being worst affected23.

Obesity has become a widely discussed factor on the public health agenda, with predictions that half the population will be obese by 205024. It is projected that the levels of obesity will continue to increase: by 2010, 33% of men, 28% of women, one-fifth of boys and more than one-fifth of girls will be obese25. The increased prevalence of poor lifestyle factors is also increasing the prevalence of chronic diseases including cancer, diabetes and coronary heart disease. The estimated cost to the NHS of obesity and related diseases is £1 billion per annum. The NHS spends around five% of its budget and this has been forecast to increase to ten% by 201126.

Obesity and related illnesses are just one area of cost (treating smokers is another major cost)27.and in total unhealthy behaviours are estimated to cost the NHS in England more than £6 billion a year28. Preventing unhealthy behaviours now should therefore be a part of any strategy to ease future pressure on the NHS.

With the economy in recession the drive towards a fitter and healthier population is vital, as periods of economic downturn have typically been associated with poorer health outcomes. Recessions, especially when sudden and severe, can have a destabilising effect on health. There are, for example, clear links between economic insecurity, poor mental health and use of mental health services29. Stress increases during recessions as individuals that stay in work are likely to have to work harder and to take less care of themselves. An HSA survey revealed that 42% of respondents indicated they would be less inclined to take time off work, while 21% said that they would be less likely to act on any lingering health issues30. The increase in unemployment during a recession is also likely to have a negative effect on health and well-being and in turn increase pressure on health services. The unemployed consult their GPs more than average and show between four and ten times the prevalence of depression and anxiety31.

18 NHS Information Centre (2008), Statistics on Obesity, Physical Activity and Diet: England, 2008.
19 Chiolero, A., et al. (2006), “Clustering of risk behaviours with cigarette consumption: A population-based survey”, Preventative Medicine, vol. 42 no. 5.
20 Department of Health (2009), Health Profile of England 2008.
21 King’s Fund (2008), Commissioning Behavioural Change: Kicking Bad Habits final report.
22 CBI (2008), At work and working well? CBI/AXA absence and labour turnover survey 2008.
23 Chartered Society of Physiotherapy (2006), Evidence submitted by the Chartered Institute of Physiotherapy to the Health Select Committee (
24 Foresight (2007), Tackling Obesities: Future Choices — Modelling Future Trends in Obesity and the Impact on Health, Government Office for Science.
25 Wanless, D. et al. (2007), Our Future Secured? A review of NHS funding and performance, King’s Fund.
26 Department of Health (2008), Health Inequalities: Progress and Next Steps.
27 Action on Smoking and Health (2008), Beyond Smoking Kills: Protecting children, reducing inequalities.
28 King’s Fund (2008), Commissioning Behavioural Change: Kicking Bad Habits — final report.
29 Catalano, R. (1991), “The Health Effects of Economic Insecurity”, American Journal of Public Health, Vol. 81 No. 9.
30 HSA (2008), HSA’s Healthy Working Report 2008: A Workforce Under Pressure.
31 Royal College of Psychiatrists (2008), Mental Health and Work.

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