Promoting healthy behaviours includes action to reduce disease, disability and early death that result from things such as smoking, our diet, how active we are and how we use alcohol and other substances.
Our behaviours are closely linked to the social, economic and environmental factors outlined in our earlier priorities. The opportunities to make healthier choices are influenced by our social and economic circumstances, by where we live and, importantly, by industries that produce a range of unhealthy products. These factors are one of the main ways that the wider determinants lead to ill health.
Our behaviours can also be a result of our mental well-being. Many of us will recognise how easy it is to eat unhealthy foods – often as a treat when we are feeling low – or how we may drink more alcohol when we feel stressed or anxious. For some people these behaviours become long-term habits, and they may need support to find healthier ways to cope. In these situations, people often need help to make changes, even when they are motivated to do so.
The leading causes of death (particularly early death in Wales), such as heart and other circulatory disease, some cancers and respiratory disease, have strong links to health behaviours as risk factors. A significant proportion of these deaths are due to things such as smoking, diet and alcohol use. Behavioural factors also play a part in the conditions which lead to disability, such as musculoskeletal diseases, and substance use.
Smoking is still the leading risk factor for poor health. This is partly because, for some diseases, the risk remains for several years even after someone has stopped smoking, particularly if they smoked for a long time. It is also due to the wide range of conditions that smoking causes, including heart and circulatory disease, dementia, cancer and lung disease. However, smoking rates have reduced significantly over recent decades, and the most recent figures suggest that only 13.8% of adults in Wales currently smoke. The Welsh Government launched their Smoke Free Wales strategy in 2022, with the goal of reducing smoking rates to below 5% by 2030.
Our diet and being overweight or obese has far more impact than tobacco use. As rates of smoking are falling, the number of overweight, and particularly obese, people is increasing. In 2022, 62% of adults in Wales were either overweight or obese and 25% were obese. This means that their weight is at a level where the risk of poor health is high. Rates of obesity are higher in people from more disadvantaged backgrounds. The Welsh Government launched Healthy Weight Healthy Wales as a long-term strategy to reduce the number of overweight and obese people. Our diet, combined with how much alcohol we drink and whether we are active, is the leading cause of being overweight or obese. Just over half of adults (56%) do the 150 minutes of moderate or vigorous activity a week recommended by the UK Chief Medical Officers. However, we know that the greatest health gains are to be made from helping the 30% of Welsh adults who are currently inactive (that is, active for less than 30 minutes a week) to become more active.
Being active depends on a range of things, including where we live, whether we have easy access to places to walk and cycle or to frequent and reliable public transport (as an alternative to a car), whether we can afford to go to a gym or leisure centre regularly, and the kind of work we do. We are becoming increasingly less active, and the need to create opportunities to be active is a relatively recent development that would not have been recognised by people 100 years ago.
Food poverty is a significant and growing problem – many families struggle to provide food at all and are much less able to focus on whether that food is healthy or not. Reversing changes which have happened over decades will not be easy, but if we do not take action, disease related to obesity will continue to increase.
During 1990 to 2016, disease caused by alcohol and drugs increased. Alcohol use is seen as normal in our society, yet the World Health Organization issued a statement in January 2023 in which it said ‘when it comes to alcohol consumption there is no safe amount that does not affect health’. Also, guidelines produced by the UK Chief Medical Officers in 2016 spoke about ‘low-risk drinking guidelines’ rather than safe levels.
This priority will focus mainly on behaviours which have the largest effect on preventable ill health, disability and early death. We are also aware of how these behaviours contribute to the health of the planet as well as the health of individuals.
We will continue our work with the health board and Directors of Public Health and local authorities to deal with the issues of smoking and obesity. We will take a similar approach to preventing harm from the use of drugs and alcohol. We have seen measurable benefits to this joint approach to tobacco use, particularly through the Help Me Quit programme, and we will aim to build on this to achieve a smoke-free Wales.
We will work to support the wider system in measuring change. This will include reducing unhealthy behaviours and the gap between those in the most and least well-off groups in society. The basis for many of these behaviours begins in childhood, and we will continue to support healthy behaviours from birth. This includes working with our partners to increase the number of women who breastfeed and advise on the best time to introduce babies to solid food. We will also develop a ‘whole school’ approach to food, which will include making sure that nutritional standards are in line with the latest scientific guidelines and seeing whether this policy improves the eating habits of children and young people.
We will take a commercial determinants of health approach, which focuses on the private- sector activities that affect population health. This approach aims to recognise and take action on those industries who manufacture products which actively encourage behaviours that are harmful to health. Wales has been active in introducing legislation to reduce the harmful effects of tobacco, and we will give the Welsh Government evidence that will help them make sure Wales remains among the leading countries in the world in tackling these issues. To do this, we will need to work closely with public health agencies in the UK and around the world to make sure we contribute to and benefit from taking action together.
We will also work to make sure that we can identify new and emerging behaviours which may be encouraged or influenced by industry. There is growing concern about issues such as gambling-related harm, and most stakeholders believe that this is at least partly due to the role of the industry. Also, there has been increasing concern about the number of young people who are vaping and the role that new attractive and flavoured single-use products may play. Confusion over cannabis and how harmful it is results partly from the actions of industry, either through promoting cannabis-derived products without active ingredients or supporting its decriminalisation.
We will investigate and respond to new and emerging health behaviours to make sure that we can promptly provide evidence and advice to the Welsh Government, the wider health system and the public. We will also continue to use behavioural science and the best available information and evidence from a growing range of sources so that we have the best possible understanding of what influences unhealthy behaviour. While we recognise that we should mainly aim to influence the wider environment (making the healthy choices the easy choices), supporting individuals will remain a main part of our work. We will support those working with individuals in the health and care system through programmes such as Making Every Contact Count.
By 2035, we will have: