"Smoking halves in 40 years," BBC News tells us, while The Guardian reports a fall in the number of heavy drinkers. Both headlines are based on an official national survey, which, as the Daily Mail points out, also found that people from the professional classes are now the biggest drinkers.
All of the reports follow the publication of the 2011 General Lifestyle Survey, compiled by the Office for National Statistics (ONS). The ONS survey data helps us understand changes in the health characteristics of British people over the years, providing us with a useful snapshot of the health of the nation.
The survey revealed three main health themes:
- there are fewer smokers now than in the 1970s
- there are fewer frequent and heavy drinkers
- there are more chronically ill and disabled people
Encouragingly for the nation’s health – and defying popular perceptions – the greatest decline in alcohol consumption has been seen among 16-24 year olds. Only half of 16-24 year olds now report drinking in the past week. Another interesting finding is that the biggest drinkers were found to be among the managerial or professional classes.
This survey provides some welcome news about two major causes of preventable death and disease (alcohol and tobacco). It also gives a clear picture of the significant level of disability and chronic illness in this country, giving those of us in good health pause for thought.
What is the General Lifestyle Survey?
The General Household Survey has been carried out every year since 1971. It was changed slightly around 1997-2000 when it was renamed the General Lifestyle Survey. The survey provides information on population, housing, employment, education and health, to allow the government to monitor changes in the demographic, social and economic characteristics of households, families and people in Great Britain.
What were the main findings of the survey?
The survey has found several key themes over the past 40 years, including a decline in household size, an increase in the number of one-parent families and one-child families, an increase in the number of people living alone and an increase in the number of people cohabiting.
The main health-related themes are related to population changes in smoking habits, drinking habits, and disease and disability.
Overall, it appears that there has been a decline in the prevalence of smoking. In 1974, almost half of those surveyed (45%) smoked compared with just 20% in 2011. There is now also less of a difference between the proportions of men and women who smoke – 51% of men and 41% of women smoked in 1974, while in 2011, 21% of men and 19% of women smoked.
There has also been a dramatic drop in the number of adults who report smoking heavily (more than 20 a day). Rates of heavy smoking fell between 1974 and 2011 from 26% to 6% of men, and from 13% to 4% of women. Along with this, the average number of cigarettes smoked per day has reduced from 18 per day for men in 1974, to 13 per day in 2011. For women there has been little change in the average number of cigarettes smoked – reducing from 13 to 12.
Married people – regardless of age – are less likely to smoke than single people, or those who are cohabiting, widowed, divorced or separated.
However, there remain stubborn socioeconomic differences in smoking prevalence. Smoking is most prevalent in households where the person surveyed (the reference person) is in a routine occupation, such as cleaning (31%), compared with households where the reference person is in a higher professional position (10%).
Overall, there has been a decline in frequent and heavy drinking since 1998. The researchers caution that changes in the way that alcohol consumption has been measured over time makes providing trend data difficult. Survey methods for alcohol have remained similar since 1998.
The survey found that the proportion of men and women who reported drinking on five or more days of the week fell – from 23% of men in 1998 to 16% in 2011, and from 13% to 9% for women. In 2011, overall, 66% of men and 54% of women reported having had any alcoholic drink in the prior seven days. The age group with the highest proportion of people not drinking at all in the past week was the 16 to 24 age group (50%).
The decline in overall drinking trends has been particularly sharp over the past five years. However, consistently since 1998, people over the age of 45 are more likely to drink on five days of the week than younger people. In 2011, 24% of men over 65 and 22% of men aged 45-64 drank on five days a week, compared with 11% of those aged 24-44 and 5% of those aged 16-24.
Since 2007 there has been a decline of almost a third in the proportion of men aged 16-24 who are heavy drinkers (eight or more units on at least one day) – 32% in 2007 compared with 22% in 2011. Similarly, over the same period the proportion of 16-24-year-old women who reported drinking heavily (six or more units on at least one day) declined from 24% to 18%.
These figures are also reflected in a drop in the proportion of men and women drinking more than their recommended daily limit of alcohol. Among men this was from 41% in 2005 to 34% in 2011 and among women from 34% in 2005 to 28% in 2011.
Alcohol consumption also differs according to socioeconomic status. However, the trend is the reverse of that seen for smoking. Where the person surveyed was in a higher managerial or professional position they were more likely to have had a drink in the past seven days (75% of men and 64% of women) compared with those in a routine occupation (59% of men and 43% of women).
Chronic illness and disability
The prevalence of self-reported chronic illness and disability rose by a fifth (from 21% to 32%) between 1972 and 1991, although the proportion has remained stable from 1991 to 2011. The proportion of people who reported that they had a long-standing illness or disability that limited their activities went up from 15% in 1975 to 19% in 2011.
The highest prevalence of reported long-standing illness or disability was among the routine or manual occupation groups (36% of men and 38% of women), followed by the intermediate group (34% of men and 35% of women), with lowest prevalence in the managerial and professional groups (28% of men and 29% of women).
What wider trends do these findings reflect?
It is difficult to point to any one thing as an explanation for these sometimes surprising figures. For instance, the decline in heavy drinking among young people might be a win for public health campaigns aimed at that group. On the other hand, it may reflect joblessness and lack of money to indulge in such activities dictated by the wider economic climate. The underlying reasons for the current trends are likely to be a highly complex mix of changing social, economic and demographic factors.
What are the health implications of the findings?
The authors say that, since smoking is the leading cause of preventable illness and premature death in the UK, reducing its prevalence has been a key objective of government policy on improving health. This has included legislation such as banning cigarette advertising in 2003 and the prohibition of smoking in enclosed work and public places in 2007. Therefore, the findings of an overall reduction in smoking among men and women are promising and may suggest that these measures are having an impact. However, the authors acknowledge that surveys underestimate cigarette smoking because people who are asked how many cigarettes they smoke each day tend to round the figure down to the nearest multiple of 10.
Similarly, excessive consumption of alcohol is another major cause of preventable illness and mortality, with almost 1.5% of all deaths in England and Wales in 2011 reported to be due to alcohol-related causes. The report says that more than 40 medical conditions have been linked to alcohol, including certain cancers, heart disease, stroke, high blood pressure and liver disease.
Self-assessed general health is used as a measure for estimating future health outcomes and is an important source for planning health services. This ONS report does not give possible reasons for the general increase in the number of people living with chronic illness. It is possible that, generally, over the 40 years there has been an increase in life expectancy and also improvements in the diagnosis of various physical and mental health conditions. This could have led to an increase in the number of people who report living with chronic illness.
The data published by the ONS makes for some mixed reading. The ongoing decline in smoking is certainly encouraging – especially as a study published earlier this week found that tobacco was the leading cause of preventable death in the UK. If this trend continues, this may soon no longer be the case.
The decline in alcohol consumption among teenagers and young people is also encouraging. Previous research has found that people who fall into a pattern of alcohol misuse at a young age are more likely to persist in the habit into later life. However, it is worrying that a significant number of the middle classes report regularly drinking to excess.
The rise in chronic disability is also troubling, although this may be an inevitable consequence of the ageing population, better diagnosis and increased levels of obesity compared with the 1970s. It may also reflect better public understanding and lower ‘stigma’ about disability that allows people today to be open about health issues that were taboo in the 1970s.
Public health messages about the dangers of smoking and alcohol misuse appear to be hitting home, as this survey suggests. However, it’s clear that a great deal more could be done to improve the health of the nation.
Analysis by Bazian
Edited by NHS Website
Links to the headlines
BBC News, 7 March 2013
The Guardian, 7 March 2013
Daily Mail, 7 March 2013
Published online March 7 2013