The NHS will fail to tackle the rising tide of obesity and tobacco related illnesses unless it adopts more sophisticated techniques including those employed by commercial advertisers to help people to live healthier lifestyles.

That is one of the conclusions of a year-long investigation into the effectiveness of different types of public health programmes to tackle smoking, alcohol misuse, poor diet and lack of exercise published today by The King's Fund.

The report finds that these behaviours are deep-rooted social habits that are not easily changed by one-off, short-lived measures. The report also adds that many NHS staff lack the necessary skills and incentives to effectively help people choose and maintain healthier lifestyles.

The King's Fund Director of Policy and report co-author, Dr Anna Dixon, said:

'The health service needs to be more innovative in how it tackles unhealthy behaviour. Obesity and the health problems associated with smoking and excessive alcohol are the biggest challenges facing the 21st-century NHS. The methods used to promote public health need to be more modern, using the most advanced techniques and technologies.

'The reasons people persist with unhealthy habits are complex. It's often about changing deep-rooted social habits that can become addictive, rather than just helping people make better choices as individuals. Financial incentives and information campaigns can be useful but are far more likely to lead to real and long-term changes in people's behaviour when paired with other interventions like tailored information and personalised support.

'But at the moment there simply isn't enough reliable data on what works and what doesn't, to help health service managers plan appropriate behaviour change programmes to meet their local needs. This lack of evidence has to be urgently addressed so more money isn't wasted on ineffective interventions.'

Commissioning and behaviour change: Kicking Bad Habits final report recommends the following.

The NHS needs to make better use of social marketing techniques and data analysis tools like geodemographics to identify, target and effectively communicate messages and motivate people to change how they live.

Public health programmes shouldn't rely on just one approach - such as information campaigns or financial incentives - as the evidence shows the most effective behaviour change interventions employ a variety of tactics.

A robust evaluation - of short- and long-term changes in behaviour and health outcomes - should be made a requirement of all public health programmes in order to build an evidence base for the future.

Frontline staff should be more proactive in promoting healthy habits to the patients they see every day and for contracts and incentives to be used to encourage such behaviour.

Government departments and local agencies involved in tackling unhealthy behaviours must better co-ordinate their efforts and ensure that targets are agreed to support their shared objectives.

Dr Dixon added:

'Encouraging healthier lifestyles is the job of all staff working within the health service, not just those working specifically in public health. GPs, pharmacists and hospital staff, the people that interact with patients every day, need to be trained in behaviour change techniques to give them the confidence to start conversations about people's unhealthy habits and to be effective in influencing their lifestyles.

'For the NHS to truly change from a service treating illness to one promoting good health, all government bodies and local health agencies need to work together. The responsibility to promote good health, as well as treat sickness, needs to be fully embedded in national policies, PCT's priorities, care providers' standards and performance indicators, and staff and service contracts.'


1. Commissioning and behaviour change; Kicking Bad Habits final report by Dr Anna Dixon, Dr Tammy Boyce and Ruth Robertson is published on Monday 8 December and will be available on The King's Fund website.

2. This report concludes a year-long investigation into the effectiveness of different types of public health interventions. The five discussion papers which fed into this report plus seminar materials including podcasts of expert panellists can be viewed on the Kicking Bad Habits project page on The King's Fund website.

3. The King's Fund seeks to understand how the health system in England can be improved. Using that insight, we help shape policy, transform services and bring about behaviour change. Our work includes research, analysis, developing leaders and improving services. We also offer a wide range of resources to help everyone working in health share knowledge, learning and ideas.

The King's Fund

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