Why clusters of lifestyle b ehaviours matter

1. Why clusters of lifestyle behaviours matter Improving Public Health Outcomes Kings Fund Conference, March 2013 Gabriella Lake Walker, April 2013

2. Overview • Introduction: Kings Fund report • Exploring and understanding multiple behaviours in young people: DECIPHer and Mentor • Fair Society: Healthy Lives (The Marmot Review) • Session two: Understanding clustering of behaviours • Session three: Putting research into practice • Summary and Conclusion

3. Introduction • Kings Fund study August 2012 • Looked at health Survey for England data • Examined how smoking, excessive alcohol use, poor diet and low physical activity levels co-occur in the population and how this distribution has changed between 2003-2008 • 2003: 33% of the population had 3 or 4 behaviours • 2008: 25% of population

4. Introduction • However improvement has been seen mainly amongst higher socioeconomic groups • 2003: People with no qualifications were 3x more likely to engage in all four behaviours • 2008: People with no qualifications were 5x more likely to engage in all four behaviours • Overall health of population therefore is improving but health inequalities are widening

5. Introduction • Silo approach in policy has led to lack of joined up and holistic working, not recognising that most people do not have single risk factors • Almost 70% of population engage in two or more risky behaviours: multiple not single risk factors • People have very different combinations of risk • Who the people are differs systematically

6. Exploring and Understanding multiple behaviours in young people: DECIPHer • Avon Longitudinal Study of Parents and Children (ALSPAC, also known as Children of the 90s) • Long-term health research project. • Biological, behavioural and family data from before birth through to late adolescence • The largest such birth cohort in the world: More than 14,000 mothers enrolled during pregnancy in 1991 and 1992, and the health and development of their children has been followed ever since • http://www.bristol.ac.uk/alspac/external/interactive/risky.htm

7. Exploring and Understanding multiple behaviours in young people: DECIPHer • Multiple behaviours particularly common with drug users • Particular behaviours are not necessarily confined to specific socioeconomic groups but numbers/clusters of health harming behaviours are greater as you go down the socioeconomic scale • Inactivity and not wearing a cycle helmet were the two health-harming behaviours most likely to be displayed as a single behaviour (10%) • 40% of 15-16 year olds had 3, 4 or 5 health-harming behaviours

8. Exploring and understanding multiple behaviours in young people • Mentor: Charity working to protect young people from alcohol and drugs • Presentation by Clare James: How risky behaviours in young people overlap • Taken from Mentor’s Thinking Prevention series of public health briefing papers.

12. Exploring Multiple Behaviours: UCL Institute of Health Equity (Marmot review) • Jessica Allen • www.instituteofhealthequity.org • Overview of Marmot Review: Fair Society Healthy Lives • Closing the inequality gap

13. Exploring Multiple Behaviours: UCL Institute of Health Equity (Marmot review)

14. Proportionate Universalism • Health Inequalities result from social inequality • Solely focusing on disadvantaged won’t work - proportionate universalism is a better approach: • Asset-based • social factors • multiple risk • Whole life course and holistic approach to prevention • Impact of economic downturn and current policy?

15. Marmot review: policy objectives A. Give every child the best start in life B. Enable all children, young people and adults to maximise their capabilities and have control over their lives. C. Create fair employment and good work for all D. Ensure a healthy standard of living for all E. Create and develop healthy and sustainable places and communities F. Strengthen the role and impact of ill-health prevention

16. National Institute of Public Health Research • www.phr.nihr.ac.uk • Research Programme to fund non-NHS interventions intended to improve behaviour • Commissioned and Specified research Programmes • Researcher-led funding • Open at different times, last one open all year • Visit website for details • Something for this group? Unique parterships are developing

17. Session Two: Understanding Multiple Behaviours • Review of research programmes into multiple behaviours

18. Session Two: Understanding Multiple Behaviours University of East London: Well London, professor Adrian Renton • Studied reaching people with multiple lifestyle risks in different ways – working with different communities to understand health-harming behaviours and why/how they occur • Working on inner-city estates with high deprivation • More people had multiple behaviours than single behaviours • Not defined by gender or socioeconomic group • Ethnicity/cultural impact? Deprived white community more likely to have multiple behaviours than deprived BME communities

19. Understanding multiple behaviours: using segmentation • Experian • Healthy Foundations • CACI ‘Wellbeing Acorn’ • Programmes to target people based on ‘who’ they are rather than behaviours • Focus on local assets: individual and community • Not expensive marketing programmes but for insight

20. Putting research into practice Bolton Hospitals: Making Every Contact Count • Train hospital staff in lifestyle and brief interventions • Spread holistic risk assessment throughout Trust Initial findings: • Holistic approach makes people less defensive • Staff changing behaviours following training • Patients prefer holistic support to targeted services

21. Putting research into practice Leeds Metropolitan University: All Together Better, Jane South • Peer support community health champion programme: • Community volunteers who, with training and support, bring their ability to relate to people and their own life experience to transform health and well-being in their communities • Large evidence base of success • http://www.altogetherbetter.org.uk/home.aspx

22. Putting Research into Practice Well at the Free: Royal Free Hospital Trust, Lucy Gate and Dr Jason Strelitz • Funded by Friends of the Royal Free: initiative to improve health and wellbeing of all acute patients • Dedicated clinic with holistic assessments and lifestyle support • Includes onward referral and intervention in the community (using existing assets) • Spread techniques through hospital clinical teams • Include specific ‘clinics within clinics’, build lifestyle assessment into clinical appointments

23. Putting research into practice Knowsley Public Health • In-house provider transferring to local authority • Designed new ‘Public Health System’ with clear and defined pathways • Break down silo working • Includes single point of contact and holistic assessment with onward specialist referral where required • Partnership working to include wider determinants

24. Summary and Conclusion • Policy needs to focus on addressing multiple risky behaviours, particularly in lower socioeconomic groups, using a holistic approach • Need integrated wellbeing services that include debt/housing/employment/training support • Include Community and peer support • Focus and build on assets within communities

25. Slides, info and further reading Questions? • http://www.kingsfund.org.uk/events/improving-public-health-outcomes (presentations tab for full presentations from the day; posters tab to view the posters with full information) • Full report that inspired the conference: http://www.kingsfund.org.uk/publications/clustering-unhealthy-behaviours-over-time