Morbidity and mortality are socially patterned: those who are least deprived, on average, live longer and in better health. While life expectancy is increasing, this increase has been greatest amongst the least deprived. Four sets of behaviour ’ smoking, overconsumption of food and alcohol and physical inactivity ’ account for 63% of deaths worldwide (WHO, 2012) ’ and are, to varying degrees, socially patterned thereby contributing to inequalities in health and life expectancy.
The social patterning of health outcomes has been studied for over 150 years, principally by sociologists and social epidemiologists, including Engels and Virchow writing in the 19th century, and Wilkinson and Marmot, writing in the 21st century. While the determinants of social patterning have received much attention, there are few data to inform strategies for reducing health inequalities, particularly through changing health-related behaviour.
Targeting behaviour to reduce health inequalities has been largely eschewed in the mainstream health inequalities literature on the grounds that the social patterning of behaviour reflects structural inequalities and social determinants and so should be changed through the latter routes.
Informed by dual-process models of behaviour, this paper will consider the evidence for the social patterning of environments and executive functioning, and the implications of these for intervening to change behaviour to reduce health inequalities.
Professor Theresa Marteau is Director of the Behaviour and Health Research Unit at the Institute of Public Health (funded by the Department of Health as the Policy Research Unit on Behaviour and Health), University of Cambridge.