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Lifestyle choice or no choice?

Blog post from Councillor David Fothergill on the impact deprivation has on living a healthy life.

It has been suggested that since people choose to smoke and choose what they eat and drink and whether they take any exercise, that the ill health caused by factors such as smoking and obesity is a matter of personal choice and not an issue of social justice or a concern of national government. However, lifestyle ‘choices’ are influenced and to a large extent limited by the social, economic and environmental conditions in which they live.

The following examples illustrate this. People’s level of physical activity is an important determinant of how long they will live and how long they will have a healthy life.

In the UK, physical inactivity directly contributes to one in six deaths.

Someone’s income will determine to a considerable extent where they can live and therefore the quality of the built environment around them, including their access to green spaces.

Those living in the most deprived areas are 10 times less likely to live in the greenest areas. Children who live close to green spaces have higher levels of physical activity. Those living closer to green spaces tend to live longer than those with no green space. So something as apparently simple as the proximity of people’s homes to a park can make a difference to the length of their lives.

Around 70,000 deaths and 475,000 hospital admissions a year are currently estimated to be attributed to smoking in England. People who work in ‘routine and manual occupations’ are more than twice as likely to be smokers as people in ‘managerial and professional occupations’. Smokers from disadvantaged areas find it more difficult to stop smoking than their more affluent neighbours, despite being just as motivated to stop smoking and just as likely to try and stop.

Research on this issue points to a number of explanations, including lack of social support, higher nicotine dependency (because people in deprived groups start smoking earlier and smoke each cigarette more fully), challenging life circumstances and factors relating to stop smoking services themselves. Whatever the explanation, the more deprived you are, the more likely you are to die of a smoking-related disease.

Being obese can increase the risk of developing a range of serious diseases, including high blood pressure (hypertension), type 2 diabetes, cardiovascular diseases, several cancers, asthma, obstructive sleep apnoea (interrupted breathing during sleep) and musculoskeletal problems. There is growing evidence on the ‘obesogenic environment’ that makes it harder for people to attain and remain at a healthy weight.

This is hardest of all for people living in the most deprived areas. Obesity disproportionately affects those in the most deprived social groups and evidence suggests that the inequalities gap in child obesity is widening. There is evidence that there are elevated levels of obesity in communities with high concentrations of fast food outlets and further evidence that such concentrations are highest in areas of greatest deprivation.

There is also evidence that the type of food on sale nearest to schools may influence the diet of school children. Again, whatever the explanation, the more deprived you are, the more likely you are to have and to die of an obesity-related condition.

All of the above are examples of how deprivation and inequalities of income and of place can impact on the ‘choices’ available to people and on their health. In many cases, it is a moot question whether what some people call ‘lifestyle choices’ are really a matter of choice at all.

Councillor David Fothergill, Chair, LGA Community Wellbeing Board