Key points

  • 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.
  • 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 introduced or proposed by 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.
  • 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.
  • 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, our review shows that 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.
  • Some of the biggest immediate gains could be made by adopting price-based policies, taxes and regulations already proposed in previous government documents. Examples include minimum unit pricing for alcohol (already introduced in Scotland and Wales); a sugar and salt reformulation tax; and raising the age of sale for tobacco from 18 to 21.
  • 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.
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