Health inequality describes the differences in health status within a population. It causes
audiences to view, interpret, and act on health care messages in different ways
and is commonly overlooked when assessing an audience.
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What causes health inequality?
Health inequality is often considered an
outcome of the complex relationship between health and socioeconomic status, termed
the ‘social gradient in health’.
However, reasons for health inequality can
also be independent of socioeconomic class. For example, inequalities have been
noted in older vs. younger people, and in sexual minority groups
and individuals with mental
health issues as compared with the population.
Although differences in access to resources
(health care, healthy food, sanitation, etc.) are often held accountable for
health inequalities, evidence suggests that this is only part of the story.
Inequality is growing.
In the early 2000’s, Britain’s health care
policy switched towards promoting individualised responsibility for health.
With this, the popularity of behaviour change interventions increased and there
were notable improvements in benchmarked behaviours. In the British population between 2003 and 2008, improvements were
observed in physical activity levels and diet, alongside reductions in smoking
and alcohol consumption.
Despite this, health inequality grew.
Individuals with no
qualifications were 3 times more
likely take part in all 4 forms of unhealthy behaviour in 2003, but this grew
to 5 times as likely in 2008.
This isn’t for lack of engagement; desires to
quit smoking are similar across socio-economic statuses, but cessation is three
times lower in the poorest social class.
What can we do to address health inequality when
developing behaviour change initiatives?
When designing a behavioural intervention
it is important to accommodate the needs of the whole audience.
Mullainathan
and Shafir argue that living with too little distorts our ability to make
logical decisions. They describe our ability to think as a set capacity ‘mental
bandwidth’. Poverty (in any sense, not just financial) captures the mind and ‘uses
up’ this bandwidth, reducing our ability to think clearly. The bandwidth
argument suggests that behavioural interventions that promote self-help are
unlikely to be effective for everyone.
Behaviour change initiatives need to
support the whole of our audience and we might need to think of new ways to
accommodate everyone’s needs. Stress
has a directly negative effect on health, but the associated feelings of
apathy can reduce the effectiveness of our behaviour change interventions. For
example, what if we provided stress management support alongside our behaviour
change messages? Reducing stress might lead to better outcomes for everyone.
Hamell draw on a deep knowledge of the behavioural sciences to design
initiatives based on a complete and detailed understanding of what really
drives health behaviour.
We believe that when you have a clear
understanding of behaviour, good things happen. We use behavioural insights to
help obtain the best outcomes for all patients. For more information about our
approach and to see what we could do for you, contact us at
at fiona@hamell.co.uk or visit the Hamell website.