Health inequality: One of the most commonly overlooked factors in behaviour change

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.   

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.