Are differential consumption patterns in health-related behaviours an explanation for persistent and widening social inequalities in health in England?

Emma Stait,Michael Calnan

doi:10.1186/s12939-016-0461-2

Emma Stait, Michael Calnan

Open Access

https://doi.org/10.1186/s12939-016-0461-2

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Abstract

BackgroundDuring the last two decades, differential consumption patterns in health-related behaviours have increasingly been highlighted as playing an important role in explaining persistent and widening health inequalities. This period has also seen government public health policies in England place a greater emphasis on changing ‘lifestyle’ behaviours, in an attempt to tackle social inequalities in health. The aim of this study was to empirically examine the variation in health-related behaviour in relation to socio-economic position, in the English adult population, to determine the nature of this relationship and whether it has changed over time.MethodsThe study population was derived from the Health Survey for England between 2001 and 2012 (n = 56,468). The relationships between health-related behaviour (smoking, fruit and vegetable intake, alcohol consumption and physical activity) and three socioeconomic indicators (educational level, occupational social class and equivilised household income) were analysed using log bi-nomial regression.ResultsThe study found that each of the three socio-economic indicators were statistically related to smoking, fruit and vegetable consumption and alcohol intake, with the strongest relationship found for smoking. For physical activity, no relationship was found in 2003 by education or income and in 2008 by occupation. Statistical analysis showed that the difference between those at the highest and lowest end of the socio-economic indicators had widened in relation to smoking, as measured by educational level, occupation and household income. A similar trend was also found for physical activity as measured by educational level and household income. However, for fruit and vegetable intake and alcohol consumption, the relationship between health-related behaviour and socio-economic position had narrowed over time as measured by education and income.ConclusionsThe findings provided only partial support for the thesis that socio-economic variations in health-related behaviours may be significant in explaining widening health inequalities. The significance of socio-economic variations in health-related behaviours might reflect both materialist and cultural explanations for socio-economic inequalities although it was not possible to separate and estimate the relative importance of these effects.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0461-2) contains supplementary material, which is available to authorized users.

Highlights

During the last two decades, differential consumption patterns in health-related behaviours have increasingly been highlighted as playing an important role in explaining persistent and widening health inequalities
The analysis focused on the consumption patterns of four health-related behaviours in English adults which were smoking, excessive alcohol consumption, low fruit and vegetable intake and lack of physical activity as these are the health-related behaviours that the government policies have targeted in their public health policies to reduce health inequalities in England [12]
Observed prevalence rates for each health-related behaviour for men and women by the lowest and highest indicators for education, occupation and income for each survey year are shown in Fig. 1, while observed prevalence rates for each health-related behaviour for each age category by the lowest and highest indicators for education, occupation and income are given in Tables S1–S4

Summary

Introduction

During the last two decades, differential consumption patterns in health-related behaviours have increasingly been highlighted as playing an important role in explaining persistent and widening health inequalities. To an extent the cultural explanation has become conflated with materialist explanations [7, 8], the explanatory power of such an approach has been contested by those who have pointed to the evidence that material factors, have a direct effect on health inequalities after allowing for the influence of health-related behaviour [9] This conflated approach has been reflected, at least to some extent, in government policies in England following the Independent Review of Health Inequalities, which placed some emphasis on reducing absolute and relative disadvantage, through attempts to reduce poverty, improve material circumstances and address income inequalities in order to tackle health inequalities [10, 11]. Despite this change in approach to addressing health inequalities, socio-economic differences in mortality rates continued to rise and the Marmot Review [14] into health inequalities in England, commissioned in 2008, reported that inequalities “cannot be attributed to genetic, bad, unhealthy behaviour or difficulties in access to health care” (p.16) but emphasized the interaction of material, social, behavioural, psychosocial and biological factors in generating socio-economic differences in heath

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