Adults who engage in three or more unhealthy behaviors are 6.1 times more likely to have fair or poor health than those who have no unhealthy behaviors, says a new report from United Health Foundation. America’s Health Rankings® Spotlight: Impact of Unhealthy Behaviors offers new insights into the prevalence and distribution of unhealthy behaviors and their effect on public health and the cost of medical care.
“We have known that individual behaviors, such as smoking or lack of physical activity, are harmful to health,’’ says Dr. Ana Fuentevilla, M.D., chief medical officer of UnitedHealthcare Community & State, speaking on behalf of the United Health Foundation. “However, this spotlight helps measure those impacts and demonstrates the increased risk when individuals adopt multiple unhealthy behaviors.”
“Every unhealthy behavior matters,’’ she added, “and by far the best thing for your health is to work on decreasing the number you do and, ideally, to avoid them all.”
The spotlight looks at the more than 70% of adults in the United States who report at least one of five unhealthy behaviors associated with chronic health problems: smoking, drinking excessively, obesity, getting insufficient sleep and being physically inactive. At greatest risk for poor health are the 25 million adults – or 12% of the adult population – with three or more such behaviors.
Each added unhealthy behavior significantly increases an individual’s odds of suboptimal health, according to the spotlight, the second in a series of United Health Foundation special reports on markers of national health. Individuals with one unhealthy behavior are twice as likely to have fair or poor health, compared with those with none of the unhealthy behaviors. For those with two behaviors, the odds of fair or poor health increase to slightly more than 3.5 times – and for those with all five behaviors, the odds jump to slightly more than 8.5 times. 

Unhealthy Behaviors and Chronic Disease


“The association between the unhealthy behaviors analyzed in the report and serious chronic diseases, such as diabetes, cancer and heart disease, is well documented, as are the costs of caring for these patients,” says Glen Stream, M.D., president and board chair of Family Medicine for America’s Health, a coalition of major family medicine organizations aimed at improving the U.S. health care system and highlighting the importance of primary care through a national campaign called Health is Primary.
“We know that we can’t just treat the disease, we need to treat the whole person,” says Stream. “This report is valuable for those of us in primary care because it highlights that importance of understanding what is happening outside the doctor’s office.”

Research shows that a small percentage of patients in the U.S. account for most of the spending on health care, he says, and “data like this are important to help us understand and quantify the risk of multiple unhealthy behaviors on a person’s health. The findings further reinforce the need to address a person’s whole health, rather than each behavior in isolation.”

Exploring the “Protective Effect” of Income & Education on Health Status

The report also shines a light on those populations most at risk of having multiple unhealthy behaviors. It finds that prevalence rates of multiple unhealthy behaviors are higher among adults with lower incomes and those with less education. In fact, it finds that both income and education have a “protective effect” – that is the higher a person’s income or education level, the less likely they are to have multiple unhealthy behaviors.
Across the country, prevalence rates for multiple unhealthy behaviors are relatively consistent for college graduates, but vary widely for those without a high school diploma – from slightly more than 13% in California to 32% in Michigan. The research also finds that the gap between rates for these two populations varies by state, from less than 10 percentage points in California and Nevada to more than 20 points in Alaska, Tennessee, and Michigan – a two-fold difference.
The findings suggest that efforts to reach those with the highest prevalence rates of multiple unhealthy behaviors should be tailored to their circumstances. Whether through workplace wellness solutions, community health coaching, or online tools that bring resources to the patient, meeting people where they are is key for helping individuals take action and lower their odds of poor health.
Addressing social factors, such as access to education and job training, have been shown to improve health and reduce health care costs. One example is the new myConnections pilot program from UnitedHealthcare (UHC). UHC recently partnered with Arizona's largest nonprofit community-development organization, Chicanos Por La Causa, Inc., to provide low-income individuals and families with access to key services, including job training.
The myConnections program in Arizona has already connected more than 250 individuals with employment opportunities, developed a partnership with Dress for Success to provide business attire to women for job interviews, and launched programs to improve food and housing support services in the region. These initiatives aim to reduce social and financial barriers, which in turn, improve health and quality of life.

How Can We Improve the Odds for Good Health?

The good news from Spotlight: Impact of Unhealthy Behaviors is that 58.5 million American adults report having zero of the five unhealthy behaviors. While there are disparities in the distribution of zero unhealthy behaviors, it is also true that Americans from every state and every socioeconomic background make up that number. For example, while 21.5% of adults aged 25 and older without a high school degree have three or more unhealthy behaviors, 16.9% have zero. 
Focusing on chronic diseases can seem overwhelming. However, Stream says addressing behaviors may present a practical way to deal with the problem. “Most of our health is made up of what we do, not what is done to us in a doctor’s office or a hospital,” he says, adding, “Those of us in the health care system need to remember that reality.  Every doctor should put the results of this report on their wall to show patients how much of their own health is truly within their control.”