Key points

  • Smoking, poor diet, physical inactivity and harmful alcohol use are leading risk factors driving the UK’s high burden of preventable ill health and premature mortality. All are socioeconomically patterned and contribute significantly to widening health inequalities. 
  • This report summarises recent trends for each of these risk factors and reviews national-level policies for England introduced or proposed by the UK government in England between 2016 and 2021 to address them. Based on our review, we assess the government’s recent policy position and point towards policy priorities for the future. 
  • Population-level interventions that impact everyone and rely on non-conscious processes are most likely to be both effective and equitable in tackling major risk factors for ill health. Yet recent government policies implemented in England have largely focused on providing information and services designed to change individual behaviour.
  • As well as relying heavily on policies that promote individual behaviour change, the strength of the government’s approach has been uneven for the leading risk factors, and decision making across departments has been disjointed. Action to tackle harmful alcohol use in England has been particularly weak. 
  • To reduce exposure to risk factors and tackle inequalities, government will need to deploy multiple policy approaches that address the complex system of influences shaping people’s behaviour. 
  • Population-level interventions that are less reliant on individual agency and aim to alter the environments in which people live should form the backbone of strategies to address smoking, alcohol use, poor diet and physical inactivity. These interventions need to be implemented alongside individual-level policies supporting those most in need. The strong role played by corporations in shaping environments and influencing individual behaviour must also be recognised and addressed in a consistent way through government policy.
  • The costs of government inaction on the leading risk factors driving ill health are clear. As the country recovers from the COVID-19 pandemic and seeks to build greater resilience against future shocks, now is the time to act.

The UK’s health looks increasingly frayed and unequal. Even prior to the pandemic, people were living more years in poor health, gains in life expectancy had stalled, and inequalities were widening. This has a costly impact on individuals, communities, public services, and the economy.

There are stark warning signs that government needs to shift its approach to improve health. Rates of childhood obesity have risen sharply in recent years and inequalities have widened. Smoking remains stubbornly high among those living in more deprived areas. Alcohol-related hospital admissions and deaths have increased and rates of harmful drinking have gone up. Physical activity levels also remain low and appear to have declined during the pandemic. 

This report reviews government policies to address these risk factors in England between 2016 and 2021. We assess the government’s approach and identify future policy priorities, finding that:

  • government has relied heavily on policies aimed at changing individual behaviour  
  • the approach has been uneven across risk factors, with particularly weak action on alcohol  
  • decision making across departments has been disjointed, undermining health improvement targets.

The upcoming health disparities white paper must present a coherent long-term strategy to address major health risk factors. Government will need to adopt multiple policy approaches, focusing on population-level action to alter the environments in which people live.  

Cite this publication

Everest G, Marshall L, Fraser C, Briggs A. Addressing the leading risk factors for ill health: A review of government policies tackling smoking, poor diet, physical inactivity and harmful alcohol use in England. The Health Foundation; 2022 (https://doi.org/10.37829/HF-2022-P10).

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