The role of health behaviours in the origin of the current epidemic of non-communicable disease is observed to have driven attempts to change behaviour. It is noted that most efforts to change health behaviours have had limited success. This paper suggests that in policy-making, discussions about behaviour change are subject to six common errors and that these errors have made the business of health-related behaviour change much more difficult than it needs to be.

That behaviour is critical to the health of the public is undeniable. The number of people in the world with type 2 diabetes is expected to rise from 366 million at the present time to 552 million in 20301; and whereas about 17 million people died from cardiovascular disease in 2008, some 23 million are expected to do so in 2030. The response to and understanding of these epidemics must involve human behaviour. However, it is not just individual behaviour which drives these epidemics. Behaviour takes place in social environments and efforts to change it must therefore take account of the social context and the political and economic forces which act directly on people's health regardless of any individual choices that they may make about their own conduct.

The importance of social, political and economic circumstances notwithstanding, the policy default has traditionally been behaviour change, abstracted from the contexts within which behaviour occurs. In some ways, this is not surprising because the drivers of the epidemics of non-communicable disease – smoking, diet, alcohol consumption and physical inactivity – are self-evidently behaviours. Foregrounding behaviour not only appeals to the apparently obvious but also achieves two other things. It avoids having to think about the complexity of the social, political and economic factors which influence people's health and sidesteps confronting the powerful vested commercial interests that may not want people to change their behaviour to more healthy ways of living.

Changing health behaviours is therefore an attractive policy approach. What we focus on here is not that the broader social and economic issues should be considered, though we do consider this to be very important. Rather we note that even in their own terms, efforts at individual behaviour change are not done very well. This is in spite of the fact that a great deal is known about the science of how to change health-related behaviour and much has been achieved, especially in smoking. The scientific literature is extensive and evidence-based guidelines from NICE, for example, carefully describe how health behaviour change interventions can be made part of standard health and social care practice.5 Yet over the years most efforts at getting people to change behaviour with respect to alcohol misuse, the prevention of obesity and promoting physical activity have had only limited success. Our thesis is that although much is known, there has been a dispiriting failure by policymakers and politicians to put into practice what the science shows to be effective, preferring instead a range of approaches based on nothing much more than anecdote, gut feeling and, above all else, common sense.

It is important to understand the conditions preceding behaviour psychologically and sociologically and to combine psychological ideas about the automatic and reflective systems with sociological ideas about social practice