Determinants of Health



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. Fewer young people (15-24) were daily smokers in 2018 (11% vs 17% in 2013). 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.
Alcohol consumption is too high in Belgium. With a mean consumption of 11 litres of pure alcohol per capita per year, Belgium is close to the European average, and as such, is among the countries with a high burden related to alcohol. Hazardous drinking, or the excessive consumption of alcohol over the whole week (more than 21 or 14 drinks per week respectively in men and women), has decreased in men (7% in 2013), which is a favourable trend. This declining trend is not observed among women (4% in 2013). The behaviour called "Risky Single Occasion Drinking, (RSOD)" or having at least 6 alcoholic drinks (> 60 g ethanol) in one setting is reported by over 8% of the adults (15+) on a weekly basis. This proportion exceeds the European average. This behaviour is 4 time more frequent in men than in women. Particularly worrying is the frequency of RSOD in young men (15-24), which reaches 20%. 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 2013, about half of the adult population was overweight, including a share of 14% of obese people (this proportion is close to the EU-15 average). The obesity prevalence is higher in Wallonia than in the other regions, particularly in men. Obesity has increased in Belgium along the years since 1997 but this trend has stabilized, except for men in Wallonia. Obesity is strongly related to the socio-economic status with a much higher obesity rate among lowest educated people. In 2014, according to the Health Behaviour in School Children survey (HBSC), 14% of the adolescents were overweight (including those who were obese). Overweight was more frequent in boys (16% vs 12% in girls), slightly more frequent in the French-speaking part of the country (15% vs 13% in the Flemish region), and more frequent in families with a lower income.
The level of physical activity is insufficient: only two thirds of adults (aged 18-64) practice at least a "minimal level" of physical activity (according to International Physical Activity Questionnaire threshold), and only one third practice enough physical activity to have a positive impact on health. Men are much more physically active than women. People of the Walloon Region are less physically active than in the other regions, while women in Brussels are more frequently active than in the other regions. Contrary to many other health behaviours there is no clear socioeconomic disparity in the practice of physical activity.
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.
Only 14% of the people meet the WHO dietary guidelines recommending to consume 400 g of fruits and vegetable daily. Sugar sweetened beverages should be avoided. More than 90% of the population consumes sugar sweetened beverages. Eating habits seem to be slightly better in Flanders; they are also strongly influenced by the socio-economic status: fruits and vegetable consumption increases, while sugar sweetened beverage consumption decreases with the educational level. Over the past 10 years, eating habits have only slightly improved.
Ultra-processed foods are food products formulated from industrial ingredients; they are associated with an increased risk of obesity and hypertension and should be avoided as far as possible. In Belgium, the consumption of ultra-processed food represents 30% of the total energy consumed, which is quite high, and this proportion has not changed over time.