Research over the last decade has shown that some of the major causes of death have come to be connected or attributed to specific ‘risk factors’ These have been, in general attributed to the individuals overall behaviour. So…in this context….lung cancer, cardiovascular disease and stokes have been attributed, largely, to smoking, Lack of excercise and alcohol consumption. It stands to reason that governments and local commissioners may find an element of appeal in this, especially when it comes to public spending, however….anyone with a practical outlook on such an approach would argue this point and advocate to educate rather than deflect. This way of looking at things also shows that those at the lower end of the social scale, suffer a disproportionate amount of disease, and therefore sends out a message that they are the subsection of society that are most likely to indulge in ‘unhealthy’ habits. An argument for the other side of this view would be that if, for instance someone at the upper end of this ‘social scale’ were to be a successful business man who fell foul to a debilitating disease which rendered him incapable of carrying out his daily routines, work, family functions, etc, then he would slowly but surely slide down the social scale and then become a statistic to support the flawed outcome stats that eventually are used to support this debate. How many times have you read articles where a death has been attributed to substances, and excessive substance use, added to the stigma surrounding the drug using community, then a little further down the line found out that there were underlying issues that contributed to the death. The daughter of a police officer in 1995 made headline news death was given to her use of MDMA, but then research brought to light that she also had an underlying heart condition and the main contributor to her death was water intoxication!! 7 litres, if I’m not mistaken, and if I am then the principle can still be taken from the statement. Although there is a need to look at the behaviours of some individuals, articles like this lead us down a path of misleading hysteria and diluted messages, it is not the way forward in public health intervention.
Health professionals, politicians, policy makers and similar guiding lights have, in all admission, promoted successfully that an individuals behaviour is not only the prime cause of ill-health but also the main factor in the maintenance of good health. Reinforced by the general media, and thus taken into the public domain, via usual routes and more increasingly social media platforms, this is being upheld with little to no critical debate around it’s scientific origin. Surely ‘Public health’ should be concerned with the the more immediate factors primarily in both the social and cultural structure which can severely affect the health status of an individual rather than the isolated activities of that individual. Dominance of health officials and commissioning bodies who are in a position to define health needs and issues according to their own criteria may well create a serious imbalance in the research being carried out, the quality of the information shared and also the policies that are subsequently adopted to address specific issues.
A flawed outlook: If we allow ourselves to focus on an individuals behaviour then we may be deflecting attention from the more real and relevant issues that cause that behaviour. Factors in social structure, class divides, etc. If we are to look at the bigger picture, it stands to reason that most individual behaviours are a result of a number of different aspects and attributes. To look at the end result and base our outcomes on solely that is an unsatisfactory way of achieving positive outcomes. If I self harm, it’s okay giving me a band aid and doing an on the spot assessment to assess where I am at at that particular moment in time but does it take away the reasons as to why I self harmed in the first place??? If I use substances as a means of self medicating, taking away the substance then leaves me with the problem and no ‘solution’ therefore I need to look at why I chose to medicate in the first place. Looking at my behaviours is not going to take away the root cause. Another dilemma with the statistical side of this is the fact that most statistics around social class and the issues surrounding are collated by middle classes. The reach of social deprivation and the adverse health experiences of those living in deprived circumstances is obviously going to be in contrast with those living in less deprived status. Mortality rates are more significant in those who are living in disadvantaged conditions. There are a number of different attributes that add to the outcome of behaviours… housing, employment, finance, economic, social interaction, All of these can contribute to a number of significant health problems Statistics have proven that perinatal mortality rates are higher in those who have low capital in the above mentioned areas in their lives. Those who own their own homes have less mortality rates than those who are living in social housing accomodation, Those in stable employment have a significantly higher mortality rate than those who are living in poverty. As I’ve already said as well, if someone is living in high quality of living standards and falls ill then their capital could significantly reduce, not being able to keep employment, not being able to provide for family, not being able to maintain bills and cost of general living, therefore they would inevitably fall from their social standing into a lower category which in turn would turn the stats….flawed.