Lifestyle determinants of health
Lifestyle or behavioural risk factors are major contributors to the increasing global prevalence of non-communicable diseases (NCDs), mainly ischaemic heart disease, cancers and respiratory disease. Although high blood pressure is the leading global risk factor for NCDs, accounting for 13% of global mortality, tobacco use, physical inactivity and overweight and obesity account for 9%, 6% and 5%, respectively, while alcohol use contributes 5% of the global burden of disease. Eight risk factors (alcohol use, tobacco use, high blood pressure, high body mass index (BMI), high cholesterol, high blood glucose, low fruit and vegetable intake and physical inactivity) account for 61% of cardiovascular deaths, the leading cause of death worldwide (Global Health Risks 2009, Non-Communicable Diseases 2010; www.who.int).
Cigarette smoking became widespread amongst European men after the First World War, reaching a peak prevalence of 70–80% around 1950 in the United Kingdom and other Western countries, followed by a steady decline to around 25% of the adult male population in the early twenty-first century. For women, the peak prevalence of smoking occurred later and the decline has been slower.
Smoking-related diseases include lung, upper respiratory tract and upper gastrointestinal cancers, ischaemic heart disease, stroke, peripheral vascular disease and chronic obstructive pulmonary disease (COPD) (Figure 20a (i)); globally, 12% of male and 6% of female deaths are attributable to smoking. Exposure to second-hand smoke also increases health risks: children living in houses where one or more adults smoke are more prone to respiratory infections.