The number of smokers has decreased over the past 15 years in Belgium. In 2018, the percentage of daily smokers was 15%, which is lower than the EU-15 average prevalence. Men are still more likely than women to smoke daily. Daily smoking is less frequent in Flanders than in Wallonia and Brussels. There are important socioeconomic differences in smoking behavior, with a proportion of daily smokers being 2.3 times higher in the lowest than in the highest educated people. Good progress has been observed but prevention should continue and focus on people from lower socio-economic backgrounds. In 2018, 4.1% of the Belgian population were regular e-cigarette users. The prevalence was highest in young men in Flanders and Wallonia. Since the health consequences of this practice are still uncertain, prevention strategies should target these groups. Among teenagers, 3.8% smoked daily in 2018. This percentage is considerably lower than in 2006 (10%). More boys than girls smoke daily, and students in vocational and technical education are more likely to be daily smokers than those in general education. Despite the decline in the prevalence of tobacco consumption among young people, an increase in the use of e-cigarettes has been observed.
Alcohol consumption is high in Belgium. The average consumption of pure alcohol in Belgium is 12 liters per capita per year, which is above the mean European consumption (11 litres). This makes Belgium one of the countries with a high disease burden related to alcohol. Hazardous drinking, or the excessive consumption of alcohol over the whole week (more than 21 or 14 drinks per week for men and women, respectively), was reported by 7.4% of men and 4.3% of women. It has decreased in men, which is a favorable trend. Weekly "risky single occasion drinking, (RSOD)", or having at least 6 alcoholic drinks (> 60 g ethanol) at a single occasion, is reported by over 7.6% of the adults (15+). This behavior is nearly 3 times more frequent in men than in women. One in ten young people in the age group 15-24 years reported a weekly episode of RSOD and also one in ten young people met the criteria for problematic alcohol consumption in the past 12 months. Young people are thus a clear target group for alcohol prevention strategies.
Weight excess is an important problem in Belgium like in most industrialized countries. In 2018, about half of the adult population was overweight (49%) and 16% was obese based on self-reported measures; objective measurements revealed even higher figures, respectively 55% and 21%. The overweight and obesity prevalences are higher in Wallonia than in the other regions. After a steady increase since 1997, the prevalence of overweight remained stable in men between 2013 and 2018 in men, but continued to increase in women. Overweight and obesity are strongly related to the socio-economic status with a much higher prevalence among people with a lower educational level. In 2018, among adolescents, the prevalence of overweight (including obesity) was 16% in boys and 14% in girls.
The level of physical activity is insufficient: less than one third (30%) of the adult population (18 years and older) met the WHO recommendations of doing at least 150 minutes of moderate-intensity aerobic physical activity throughout the week. More men (36%) complied than women (25%). Residents of Flanders (37%) and people with tertiary education (38%) were more likely to meet the recommendations. Among children aged 11 to 18 years, one boy out of five (20%) and one girl out of eight (13%), met the WHO recommendations of performing at least 60 minutes of moderate- to vigorous-intensity physical activity per day.
The Belgian diet is characterized on one side by excessive consumption of red meat, processed meats, and sugar sweetened beverages, and on the other side by insufficient consumption of fruits, vegetables, nuts and seeds, milk, eggs and fish.
In 2018, only 13% of the population aged 6 years and over met the WHO dietary guidelines recommending to consume at least 5 portions of fruits and vegetable per day. Sugar sweetened beverages should be avoided, but 20% of the population consumes daily sugary drinks. Nutritional habits seem to be better in Brussels, among women and older people, and people with a higher educational level.
One-third of the population aged 15 years and over do not have sufficient skills to make decisions about their health. People in poor health, older people, and lower educated people have a lower level of health literacy; in other words, people who have higher needs for healthcare and health promotion, are those who benefit the least from such interventions. Attention is therefore needed to detect people with low health literacy and adapt the communication; it is however also important to improve the health literacy levels in the population.
Poor air quality is an important contributor to disease and premature mortality in Belgium, attributed to various atmospheric pollutants. While exposure to particulate matter (PM) is decreasing in Belgium, two-thirds of the population is exposed to general PM levels exceeding the WHO’s advised value, while over 90% is exposed to hazardous concentrations of the fine PM fraction. Internationally, Belgium has the 4th highest PM exposure compared to similar EU-14 countries. Exposure to nitrogen dioxide (NO2) is decreasing in Belgium, but 20% of the people is still exposed to above-recommended values, mostly in urban areas. Belgium ranks 5th in NO2 exposure, compared to the EU-14. In contrast to the other pollutants, exposure to ozone (O3) is slightly increasing in Belgium, and the entire population is exposed to concentrations that exceed the guideline value. Internationally, Belgium has the 6th lowest exposure to O3, below the EU-14 average.