Abstract
BackgroundWithin affluent populations, there are marked socioeconomic gradients in health behavior, with people of lower socioeconomic position smoking more, exercising less, having poorer diets, complying less well with therapy, using medical services less, ignoring health and safety advice more, and being less health-conscious overall, than their more affluent peers. Whilst the proximate mechanisms underlying these behavioral differences have been investigated, the ultimate causes have not.Methodology/Principal FindingsThis paper presents a theoretical model of why socioeconomic gradients in health behavior might be found. I conjecture that lower socioeconomic position is associated with greater exposure to extrinsic mortality risks (that is, risks that cannot be mitigated through behavior), and that health behavior competes for people's time and energy against other activities which contribute to their fitness. Under these two assumptions, the model shows that the optimal amount of health behavior to perform is indeed less for people of lower socioeconomic position.Conclusions/SignificanceThe model predicts an exacerbatory dynamic of poverty, whereby the greater exposure of poor people to unavoidable harms engenders a disinvestment in health behavior, resulting in a final inequality in health outcomes which is greater than the initial inequality in material conditions. I discuss the assumptions of the model, and its implications for strategies for the reduction of health inequalities.
Highlights
Within economically developed countries, there are large differentials in long-term health outcomes between people of different socioeconomic positions [1,2,3]
The incentive to forego smoking is small for population sub-groups who are likely to die from some other cause anyway before the effects of their smoking lead to disease [26]. If we extend this argument to all health behaviors, though, there seems to be a danger of circularity, since we end up explaining neglect of health behavior by low life expectancy, whilst low life expectancy is itself caused, to a considerable extent, by neglect of health behavior
If it is the case that lower socioeconomic position is associated with a greater rate of extrinsic hazards, we should expect people to respond to lower socioeconomic position with reduced preventative health behavior, because the benefits of that behavior to them are lessened
Summary
There are large differentials in long-term health outcomes between people of different socioeconomic positions [1,2,3]. People of lower socioeconomic position have been found to smoke more, exercise less, have poorer diets, comply less well with therapy, use medical services less, adopt fewer safety measures, ignore health advice more, and be less health-conscious overall, than their more affluent peers [7,8,9,10,11,12,13,14,15,16,17,18] Some of these behaviors can be put down to financial constraints, as healthy diets, for example, cost more than unhealthy ones, but socioeconomic gradients are found even where the health behaviors in question would cost nothing, ruling out income differences as the explanation. Whilst the proximate mechanisms underlying these behavioral differences have been investigated, the ultimate causes have not
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