Introduction

Our behaviour has a substantial impact on our health. In this chapter, we focus on how behaviour patterns can be changed to prevent and manage illness and promote wellbeing and on how we can identify effective and useful behaviour change interventions. Behaviour patterns that influence health and wellbeing have become topical as evidence accumulates regarding the impact of smoking, alcohol consumption, overeating and sedentary lifestyles on population health and the cost of health services. For example, in England, 64% of the population is overweight or obese, with 25% classified as obese (Public Health England, 2012). By 2050 60% of men, 50% of women and 25% of children are predicted to be obese, having a substantial impact on people's physical and psychological wellbeing (Kushner and Foster, 2000), as well as costing an additional £45.5 billion per year (Butland et al, 2007). Unsurprisingly then, a review of the UK NHS (Wanless, 2002) concluded that national health services would only remain affordable if the population became more engaged in their own healthcare. These concerns have also raised the issue of rationing public health services on the grounds that some interventions may only be effective for those leading ‘healthy’ lifestyles. For example, are hip replacements less effective for obese people? Despite a lack of evidence that this may be the case (Judge et al, 2014) such concerns are having an impact on health services.

Nonetheless, there is clear evidence that key behaviour patterns damage health and decrease longevity. More than 40 years ago, the Alameda County study of health-related behaviour patterns followed 7,000 people over 10 years and showed that amount of sleep, exercise patterns, alcohol consumption, and eating habits predicted mortality (Belloc and Breslow, 1972). Similarly, following 4,886 individuals, Kvaavik et al (2010) found that those who smoked, consumed less than three portions of fruit and vegetables daily, did less than two hours physical activity per week and consumed more than 14 units of alcohol had an all-cause mortality risk equivalent to being 12 years older than those that did none of the above.

Fortunately, interventions to change behaviour can be effective. Reductions in smoking and unsafe sexual behaviour, increases in physical activity, healthy diets, self-care and health screening have all been observed following particular interventions (for example, Greaves et al, 2011; Denford et al, 2013).