One in 50 people in England face ‘triple threat’ of early death

Combined effects of multiple risk factors is greater than sum of individual risks, prompting experts to call for coherent approach in the NHS 10-Year Health Plan

New analysis has revealed that one in 50 people aged 16 or older in England are at risk of an early death because they smoke, drink too much and are overweight.

This ‘triple threat’ could exponentially raise their risk of diseases including cancer, cardiovascular disease, stroke, type-2 diabetes, liver disease, and mental health conditions.

The analysis of data from the Health Survey for England (HSE), conducted by charity Action on Smoking and Health (ASH), also revealed that 22% of people in England – over 10 million people – are living with two or more risk factors: either smoking, drinking alcohol above safer guidelines, and living with overweight or obesity.

In addition, people living in more deprived areas are disproportionately affected, with 24% of those in the most deprived quintile presenting at least two risk factors, compared to 19% in the least deprived quintile.

Caroline Cerny, Deputy Chief Executive of ASH and lead of a collaboration between ASH, the Alcohol Health Alliance and the Obesity Health Alliance, said, “This new analysis shows how harm from smoking, alcohol and unhealthy food are not separate problems. Yet public health strategies often treat them separately, missing vital opportunities for joined-up action.

“The upcoming 10-year plan is an opportunity for this government to do what previous governments have failed to do and get a firm grip on the causes of ill health that is shortening the lives of people and placing a huge strain on the NHS.”

The snapshot analysis of 2021 HSE data found that:

• 9 million people have overweight/obesity and increasing/higher risk drinking risk factors (13% of people aged 16 and over)
• 5 million have overweight/obesity and smoking risk factors (6% of people aged 16 and over)
• 6 million have increasing or higher risk drinking and smoking risk factors (1% of people aged 16 and over)
• 1 million have all three risk factors (2% of people aged 16 and over)

Evidence shows living with multiple co-occurring risk factors significantly increases vulnerability to illness and early death, with their combined effects often being greater than the sum of individual risks. There are also strong associations between the risk factors – e.g. drinking alcohol can reduce inhibitions which can lead to smoking and different eating patterns.

"We urgently need a joined-up approach to public health policymaking that tackles these issues together, rather than in isolation...”

Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance said, “Smoking, alcohol and excess weight each significantly increase the risk of serious health problems like cancer, heart disease and liver disease. When these risk factors are combined, the danger to people’s health is even greater – leading to higher chances of early death and more years lived in poor health. These poor health outcomes are not only avoidable, but they also place a huge and growing strain on the NHS and our economy.

"We urgently need a joined-up approach to public health policymaking that tackles these issues together, rather than in isolation, if we are to see the much-needed governmental shift from sickness to prevention.”

Katharine Jenner, Director of the Obesity Health Alliance pointed to the broader picture. “Behind the statistics on smoking, alcohol, and unhealthy food-related disease lie multi-million pound industries that operate in darkly similar ways - producing, marketing, and selling products that damage our well being. The government will not be able to meet its ambition of shifting from prevention to treatment until it recognises this.”

The organisations are calling on the upcoming NHS 10-year plan to take a coherent approach to addressing these risk factors together.