Lifestyles and health behaviour
determinants of health-enhancing
behaviours
What are health behaviours?
 Kasl and Cobb (1966) defined three types of
health related behaviours. They suggested that;



a health behaviour is a behaviour aimed at preventing
disease (e.g. eating a healthy diet);
an illness behaviour is a behaviour aimed at seeking a
remedy (e.g. going to the doctor);
a sick role behaviour is an activity aimed at getting
well (e.g. taking prescribed medication or resting).
What are health behaviours?
 Health behaviours have also being defined by
Matarazzo (1984) in terms of either:


Health impairing habits, which he called "behavioural
pathogens" (for example smoking, eating a high fat
diet), or
Health protective behaviours, which he defined as
"behavioural immunogens" (e.g. attending a health
check).
Behaviour and mortality
 50% of mortality from the 10 leading causes of death is
due to behaviour.
 Doll and Peto (1981) estimated that 75% of cancer
deaths were related to behaviour. 90% of all lung cancer
mortality is attributable to cigarette smoking, which is also
linked to other illnesses such as cancers of the bladder,
pancreas, mouth, and oesophagus and coronary heart
disease. Bowel cancer is linked to behaviours such as a
diet high in total fat, high in meat and low in fibre.
Lifestyle and
health
About 50% of premature deaths in western
countries can be attributed to lifestyle
(Hamburg et al., 1982). Smokers, on average,
reduce their life expectancy by five years and
individuals who lead a sedentary (i.e. none
active) lifestyle by two to three years
(Bennett and Murphy, 1997).
Lifestyle and
health
Holy Four
 Four behaviours in particular are associated with
disease: smoking, alcohol misuse, poor nutrition
and lower levels of exercise; these are called the
“holy four”.
 Conversely, rarely eating between meals, sleeping
for seven to eight hours each night, and eating
breakfast nearly every day have been associated
with good health and longevity (Breslow and
Enstrom 1980). Recently high-risk sexual activity
has been added to the risk factor list.
Belloc and Breslow (1972)
 Belloc and Breslow (1972) conducted an
epidemiological study asking a representative
sample of 6928 residents of Almeida County,
California whether they engaged in the
following seven health practises:
Belloc and Breslow (1972)
1.
2.
3.
4.
5.
6.
7.
sleeping seven to eight hours daily
eating breakfast almost every day
never or rarely eating between meals
currently being at or near prescribed height
adjusted weight
never smoking cigarettes
moderate or no use of alcohol
regular physical activity.
Positive attitude
 Having a positive attitude towards life
has been found to increase longevity
(Levy et al, 2002). The team used data
gathered in 1975 in Oxford, Ohio, where
almost everybody over 50 was
questioned about their life and health. By
tracing the deaths of participants over 23
years, the team was able to match
lifespan against attitudes towards ageing
expressed at the start.
Positive attitude
 Participants had been asked to agree or disagree
with statements such as: “Things keep getting
worse as I get older” or “I have as much pep as I
did last year” or “I am as happy now as I was when
I was younger.” The participants were scored on a
scale of zero to five, in which five represented the
most positive attitude towards growing older and
zero the most negative.
Positive attitude
 In the Journal of Personality and Social
Psychology, the team says that the median
survival for the most negative thinkers was
15 years, while for the most positive it was
22.5 years.
 Controlling for age, sex, wealth, health and
loneliness did not alter the finding.
Evaluation
 There are several methodological criticisms that can
be made of the original study by Belloc and
Breslow and the follow-up studies. First, the sample
is not particularly representative as all the
participants came from the same area in the USA.
 Second, the study establishes a correlation between
seven specific health preventive behaviours and
longevity, but does not prove that these behaviours
actually caused some of the participants to live
longer. It is possible, although unlikely, that some
other factor — personality, for example — affected
both behaviour and lifespan.
Evaluation
 The ‘behavioural change’ approach to promoting
health raises a couple of ethical issues. First, it can
lead to ‘victim-blaming’. If we believe too strongly
that individuals can prevent themselves from falling
ill by choosing to carry out health preventive
behaviours, then we may go on to blame those
individuals for failing to protect their own health if
they do fall ill.
Evaluation
 There have been cases where doctors have
refused to treat certain patients because they
felt that they had brought their illnesses on
themselves. The greatest contributions to
health have been through developments in
medical science and through public health
initiatives such as improved sanitation, and
not through individual behavioural change.
Evaluation
 The second problem with the behavioural
change approach is the narrow line that
exists between persuading someone to
change his or her behaviour and coercion.
Do we have a right to assume that we
know better than someone else what is
best for their own health, and to force
them to change their behaviour?
Genetic theories
 Is it possible, however, for a person’s genetic
inheritance to directly affect their healthrelated behaviour? It may be, for example,
that alcoholism is partly hereditary. In his
book on this topic, Sher (1991) describes
evidence that the children of alcoholics are
more likely to become alcoholic themselves.
Genetic theories
 Although it is notoriously
difficult to determine whether
a correlation such as this is
due to genetic factors or arises
as a result of social learning,
some psychologists argue that,
although there probably is no
such thing as an ‘alcoholism
gene’, certain genetically
inherited personality traits
may pre-dispose an individual
towards alcohol abuse.
Family genetics and history of
dietary risk factors.
 Several studies have provided evidence
that family history of dietary risk factors
may be related to adolescents’ food
preferences. Fischer and Dyer (1981)
reported that family history of obesity was
related to increased intake of sweets, dairy
products, and fatty foods in a sample of
116 high school girls. Their results also
indicated that having a family history of
heart problems was related to decreased
consumption of milk, eggs, and salty
foods.
Family genetics and history of
dietary risk factors.
 Levine, Lewy, and New (1976) found a
family history of hypertension to be
associated with a greater prevalence of
obesity among African American
adolescents. Some investigators have
also analyzed dietary intake among twin
populations as evidence of a genetic
variance for nutrient intake. In one of
these studies, De Castro (1993) found
significant heritabilities for identical and
fraternal twins with regard to the
amount
of
food
energy
and
macronutrients eaten daily.
Family genetics and history of
dietary risk factors.
 In contrast, Fabsitz, Garrison, Feinleib, and
Hjortland (1978) demonstrated that, in addition to a
genetic variance, environmental effects (e.g., how
frequently twins saw each other) were important in
accounting for similarities in twins’ nutrient intakes.
These results suggest that there may be an
interaction between genetic and environmental
factors that influence eating behaviors among
adolescents.
Genetic theories
 Genetic theories suggest that there may be a
genetic predisposition to becoming an
alcoholic or a smoker. To examine the
influences of genetics, researchers have
examined either identical twins reared apart
or the relationship between adoptees and
their
biological
parents.
These
methodologies tease apart the separate
effects of environment and genetics.
Genetic theories
 In an early study on genetics and smoking, Sheilds
(1962) reported that of 42 twins reared apart, only 9
were discordant (showed different smoking
behaviour). He reported that 18 pairs were both
non-smokers and 15 pairs were both smokers. This
is a much higher rate of concordance than predicted
by chance. Evidence for a genetic factor in smoking
has also been reported by Eysenck (1990) and in an
Australian study examining the role of genetics in
both the uptake of smoking (initiation) and
committed smoking (maintenance) (Murray et al.
1985).
Genetic theories
 Research into the role of genetics in
alcoholism has been more extensive
and reviews of this literature can be
found elsewhere (Peele 1984;
Schuckit 1985). However, it has been
estimated that a male child may be
up to four times more likely to
develop alcoholism if he has a
biological parent who is an alcoholic.
Behaviourist learning
theories
 Classical conditioning is a process in which
the individual associates an automatic
response with a neutral stimulus. Ivan Pavlov
(1849—1936) described this process after he
noticed that laboratory dogs would salivate
when he turned a light on because they had
learnt to associate the light with the presence
of food.
Behaviourist learning
theories
Behaviourist learning
theories
 Classical conditioning could explain certain healthrelated behaviours such as ‘comfort eating’, for
example. If a parent regularly offers a child sweets
or chocolate at the same time as physical and
emotional affection, then the child may learn to
associate sweet foods with the reassuring feelings
that arise out of parental love. In later life, the child
may try to recreate these pleasant feelings by eating
chocolate when he or she is stressed or depressed.
Behaviourist learning
theories
Operant conditioning
 Operant conditioning is when people respond to
reward or punishment by either repeating a
particular behaviour, or else stopping it. If an
individual carries out a behaviour that clearly seems
to be bad for his or her health, such as smoking
cigarettes, a deeper look may well reveal benefits
for the individual, such as social approval, the
nicotine buzz and so on.
Operant conditioning
 A striking example of how operant conditioning can
affect health behaviour is the study by Gil et al
(1988). They conducted research on children
suffering from a chronic skin disorder that causes
severe itching. They videotaped the children with
their parents in the hospital and observed that when
parents tried to stop their children scratching (in
order to prevent peeling and infection) this actually
increased the scratching behaviour by rewarding it
with attention.
Operant conditioning
 When they asked parents to ignore their children
when they scratched and give them positive
attention when they did not scratch, the amount of
scratching was significantly reduced.
 Drinking, eating, smoking, drug and sexual
addictions all have the ‘irrational’ characteristic that
the total amount of pleasure gained from the
addiction seems much less than the suffering caused
by it. According to learning theorists, the reason for
this lies in the nature of the gradient of
reinforcement.
Operant conditioning
 Addictive behaviours are typically those in
which pleasurable effects occur rapidly after
the addictive behaviour while unpleasant
consequences occur after a delay. The simple
mechanism of operant conditioning and the
gradient of reinforcement is able, as it were,
to overpower the mind’s capacity for rational
calculation.
Social learning
 Social learning occurs when an individual
observes and imitates another person’s
behaviour, either because the individual
looks up to that person as a role model or
else through vicarious reinforcement —
that is, .the individual sees the person being
rewarded for his or her actions.
Social learning
 Social learning can clearly be very influential
in encouraging people to do things that are
bad for their health (for example, a teenager
may take up smoking because he or she has
an admired elder brother who smokes, or
may try illegal drugs because he or she sees
other people taking them and having a good
time).
Social learning
 Another example of how vicarious reinforcement can lead to
unhealthy behaviour concerns young women with eating
disorders, who see images of very thin models in magazines
being rewarded with success, money, glamour and fame. On
the other hand, many health promotion campaigns use
positive role models to try to get people to lead healthier
lifestyles. The advertising industry, whose reason for
existing is to persuade people to change their behaviour,
often depicts successful, good-looking and happy people
using a certain product in the hope that this will make others
want to use the product as well.
Social learning
self-efficacy
 Bandura (1977) has been particularly influential in
emphasising the importance of learning by
imitation in linking it to his concept of self-efficacy,
personality traits consisting of having confidence in
one’s ability to carry out one’s plans successfully.
People with lower self-efficacy are much more
likely to imitate undesirable behaviours than those
with higher self-efficacy.
self-efficacy
 Heather and Robertson (1997) give a useful
discussion of the application of these principles to
drinking. Patterns of drinking by parents are
observed by children who may then imitate them in
later life, especially the behaviour of the same sex
parents. In adolescence, the drinking behaviour of
respected older peers may also be imitated, and
subsequently that of higher status colleagues at
work, a phenomena, which may explain the
prevalence of heavy drinking in certain professions
such as medicine and journalism.
Commentary
 Many psychologists criticize behaviouristlearning theories on the grounds that they are
too mechanistic. In other words, they
assume that human beings respond
automatically to specific situations. Not only
does this imply a lack of freewill, but also it
also ignores the effect on behaviour of
cognitive factors.
Social and environmental
factors
 There are many different social and environmental
factors contributing to people’s health behaviour.
For example, a common explanation for young
people taking drugs or smoking cigarettes is ‘peer
pressure’. It may be that people imitate their peers
because of the explanation given above — that is,
vicarious reinforcement; they see others getting a
reward for a certain behaviour, so they copy it.
Social and environmental
factors
 Social factors such as culture influence
dietary behaviour.
Culture affects an
individual’s food selection, preparation, and
eating patterns. Certain tastes or food are
associated with specific feelings and
meanings within a culture (for example, soul
food may denote fried and barbecue meats
within the African American community).
Social and environmental
factors
 Mexican American women often feel
uncomfortable with focusing on themselves
as individuals therefore a successful
approach to losing weight would target the
whole family rather than the individual
woman (Foreyt et al, 1991).
Social and environmental
factors
 Television advertising also exerts a larger influence
over dietary behaviour. Advertisers often target
adolescents by promoting fast foods high in fat,
cholesterol, sodium, and sugar. It has been found
that children’s television viewing positively
correlates with smoking behaviour and attempts to
influence parents shopping selections (Dietz and
Gortmaker, 1985). Television viewing is also
highly correlated with obesity in children (Bowen et
al, 1991).
Commentary
 • Conformity does not exert an equally
strong influence in all situations and with
all individuals, It is likely to be more
powerful in ambiguous situations, when
others are perceived as having more
expertise, or when the individual has low
self-confidence, poor self-esteem and a
weak sense of self-efficacy.
High-risk sexual behaviour
 Hawkins et al. (1995) reported that the most
frequent safer sex behaviour amongst well-educated
heterosexual students was the use of the
contraceptive pill. The least frequent sexual
practice, reported by only 24% of the sample, was
the use of condoms. An important factor is that the
majority of young persons do not see themselves as
at risk of HIV infection or have feelings of
invulnerability towards the disease.
Exercise
Those who are physically active throughout the adult
life live longer than those who are sedentary.
Paffenburger et al (1986) monitored leisure time
activity in a cohort of 17000 Harvard graduates
dating back to 1916. Using questionnaires it was
found that those who were least active after
graduation had a 64% increased risk of heart attack
compared with their more energetic classmates.
Those who expended more than 2000 calories of
energy in active leisure activities per week lived, on
average, two and a half years longer than those
classified as inactive.
Exercise
About a quarter of the UK population engage in health
promoting levels of exercise, with a similar picture
in the USA. In recent years these levels have
dramatically increased. For example in Wales 20%
of men and 2% of women took sufficient exercise
in 1985 but by 1990 this had increased to 27% of
the population. Those who engage in exercise are
more likely to be young, male and well-educated
adults, members of higher socio-economic groups,
and those who have exercised in the past.
Exercise
Those least likely to exercise tend to be in the lower
socio-economic groups, older individuals, and those
whose health is likely to be at risk as a consequence
of being overweight and smoking cigarettes
(Dishman 1982). Obstacles to exercise include not
having enough time, lack of support from family or
friends and perceived incapacity due to ageing.
five different types of exercise.
 Brannon & Feist (1997) describe five
different types of exercise.
1.Isometric exercise involves pushing the
muscles hard against each other or against an
immovable object. The exercise strengthens
muscle groups but is not effective for overall
conditioning.
five different types of exercise.
2. Isotonic exercise involves the contraction
of muscles and the movement of joints, as
in weight lifting. Muscle strength and
endurance may be improved but the general
improvement is in body appearance rather
than improving fitness and health.
five different types of exercise.
3. Isokinetic exercise uses specialised
equipment that requires exertion for lifting
and additional effort to return to the starting
position. This exercise is more effective
than both isometric and isotonic exercise
and promotes muscle strength and muscle
endurance (Pipes and Wilmore, 1975).
five different types of exercise.
4. Anaerobic exercise involves short, intensive
bursts of energy without an increased amount of
oxygen such as in short distance running. Such
exercises improve speed and endurance but do not
increase the fitness of the coronary and
respiratory systems and indeed may be dangerous
for people with coronary heart disease.
five different types of exercise.
5. Aerobic exercise requires dramatically increased
oxygen consumption over an extended period of
time such as in jogging, walking, dancing, rope
skipping, swimming and cycling. The heart rate
must be in a certain range which is computed
from a formula based on age and the maximum
possible heart rate. The heart rate should stay at
this elevated level for at least 12 minutes, and
preferably 15 to 30 minutes. This exercise
improves the respiratory system and the coronary
system.
Organic & Dynamic Fitness
 Kuntzleman (1978)
Organic fitness-our capacity for action and
movement determined by inherent factors
such as genes, age and health status.
Dynamic fitness-determined by our
experience.
London bus crews
 Maurice et al. (1953)
studied London double
decker bus drivers and
their conductors. The
more active conductors
had significantly less
incidence of C. H. D.
than did the sedentary
drivers. Can you think
of any confounding
factors in this study?
Exercise
 Exercise has been found to lower depressive
moods in a variety of people, including
young pregnant women from ethnically
diverse backgrounds (Koniak-Griffin, 1994)
and nursing home residents aged 66 to 97
(Ruuskanen and Parkatti, 1994). These
findings could be due to the release of
endogenous Opiates during exercise.
Exercise
 Exercise is a buffer against stress. This could be
because of the positive effect on the immune
system. Exercise produces a rise in natural killer
cell activity and an increase in the percentage of Tcells (lymphocytes) that bear natural killer cell
markers (indicating the sites where killer cells are
produced). This warns off invading cells before
they have the chance to harm the body.
Exercise
 Both exercise and stress reduce adrenaline and
other hormones yet exercise has a beneficial effect
on heart functioning whereas stress may produce
lesions in heart tissue. In exercise adrenaline
metabolises differently and is released infrequently
and gradually under conditions for which it was
intended (e.g. jogging). In conditions of stress
adrenaline is discharged in a chronic and enhanced
manner.
Dietary habits
 The MRFIT study (Stamler et al. 1986), was a
longitudinal study over six years of three hundred
and fifty thousand adults. A linear relationship was
found between blood cholesterol level and the
incidence of coronary heart disease (CHD) or
stroke. The risk for individuals within the top third
of cholesterol levels was three and a half times
greater than those in the lowest third.
Dietary habits
 A 24 year longitudinal study of American
men working for western electricity found
that men who consumed high levels of
cholesterol were twice as likely to develop
lung cancer compared with men who
consumed low levels of cholesterol. Much of
the cholesterol came from eggs (Shekelle et
al, 1991).
Dietary habits
 High fibre diets protect men and women
from cancer of the colon and the rectum.
Fibre from fruits and vegetables offer more
protection against colon cancer than that
from cereals and other grains. Fruit
consumption offers protection against lung
cancer and we should be eating fruit 3 to 7
times per week (Fraser et al, 1991).
Obesity and eating disorders
 More than a quarter of children in English
secondary schools are clinically obese,
almost double the proportion a decade
ago, and an official survey released in
April 2006 also showed that girls were
suffering more than boys from a crisp
and chocolate-fuelled life of too much
eating and too little exercise.
Obesity and eating disorders
 Researchers measured the height and
weight of 11-15 year olds, and found
26.7% of girls and 24.2% of boys
qualified as obese - nearly double the
rate in 1995. Among children aged 2-10,
12.8% of girls and 15.9% of boys
weighed above the obesity threshold also well up on 10 years before.
Obesity and eating disorders
 The increase in obesity accelerated
sharply in 2004, especially among girls,
the survey said. Figures for the 11-15
age group showed the proportion of
obese girls grew from 15.4% in 1995 to
22.1% in 2003. But in 2004 it shot up to
26.7%.
Obesity and eating disorders
 The survey also found that the obesity
rate among adults had risen to 24%, in
spite of people exercising more and
eating more fruit and vegetables.
 However, more men gave up smoking
than women, and in 2004 there were for
the first time more women smokers
(23%) than there were men (22%).
Obesity and eating disorders
 Obesity is defined in terms of the percentage
and distribution of an individual's body fat.
Techniques used to assess the body fat range
from using computer tomography (e.g.
ultrasound waves) to magnetic resonance
imaging (MRI). Obesity may also be defined in
terms of body mass index (B. M. I.) which is
calculated by dividing a person's weight by
their height squared using metric units (i.e.
kilogrammes and metres squared).
Obesity and eating disorders
 Stunkarda (1984) suggested that obesity
should be categorised as either mild (20
to 40% overweight), moderate (41 to
100% overweight) or severe (more than
100% overweight). This would suggest
that 24% of American men and 27% of
American women are at least mildly
obese (Kuczmarski, 1992).
Obesity
 There are three different types of theories that
attempt to explain obesity; they are:
1.
2.
3.
Physiological theories suggesting that there are genetic
elements.
Metabolic rate theories proposing that obese people
have a lower resting metabolic rate, burn up less calories
when resting and therefore require less food. They also
tend to have more fat cells which are genetically
determined.
Behavioural theories suggest that obese people tend to
be less physically active and eat more food than required.
Eating disorders
 The two main eating disorders are anorexia
nervosa and bulimia.
Anorexia
 Individuals are diagnosed as anorexic only if they weigh at
least 15% less than their minimal normal weight and have
stopped menstruating. In extreme cases, anorexics may
weight less than 50% of their normal weight. Weight loss
leads to a number of potentially dangerous side-effects,
including emaciation (wasting of the body), susceptibility to
infection and other symptoms of under nourishment.
Females are 20 times more likely to develop anorexia than
males. But horseracing Jockeys, who are usually male, are
susceptible to anorexia. Anorexia particularly affects white,
Western, middle to upper class, teenage women.
Anorexia
 Another characteristic of anorexia nervosa is that of
distortion of body image. Anorexics think that they are too
fat. This was investigated by Garfinkel and Garner (1982).
Participants used a device that could adjust pictures of
themselves and others up to 20 per cent above or below their
actual body size. An anorexic was more likely to adjust the
picture of herself so that it was larger than the actual size.
They did not do the same for photographs of other people.
Anorexia
 American undergraduates were shown figures of
their own sex and asked to indicate the figure that
looked most like their own shape, their ideal figure
and the figure they found would be most attractive
to the opposite sex. Men selected very similar
figures for all three body shapes! Women chose
ideal and attractive body shapes that were much
thinner than the shape that was indicated as
representing their current shape. Women tended to
choose thinner body shapes for all three choices
(ideal, attractive and current) compared to the men
(Fallon and Rozin, 1985).
Anorexia
 The perfect figure has changed over the
years. In the 1950s female sex symbols had
much larger bodies compared with presentday female sex symbols.
Anorexia
 The hypothalamus is implicated in anorexia.
The hypothalamus controls both eating and
hormonal functions (which may also explain
irregularities in menstruation).
Anorexia
 Personality factors and family dynamics could also
play a part in anorexia. The anorexic lacks selfconfidence, needs approval, is conscientious, is a
perfectionist and feels the pressure to succeed
(Taylor, 1995).
 Parental psychopathology or alcoholism also plays
a part as does being in an extremely close or
interdependent family with poor skills for
communicating emotion or dealing with conflict
(Rakoff, 1983).
Anorexia
 The mother daughter relationship has been
implicated. Mothers of anorexic daughters tend to
be dissatisfied with their daughter's appearance and
tend to be vulnerable to eating disorders themselves
(Pike and Rodin, 1991).
 Genetics could explain this result as De Castro
(2001) has found that identical twins have similar
eating patterns compared with fraternal twins
Bulimia
 Bulimia is characterised by recurrent episodes of
binge eating followed by attempts to purge the
excess eating by vomiting or using laxatives. The
binges occur at least once a day usually in the
evening and when alone. Vomiting and the use of
laxatives disrupts the balance of the electrolyte
potassium resulting in dehydration, cardiac
arrhythmias and urinary infections.
Bulimia
 This disorder mainly affects young women and is
more common than anorexia affecting five to ten%
of American women. Bulimia is not confined to
middle or upper-class females and transcends racial,
ethnic and socioeconomic boundaries. Like
anorexia explanations encompass biological,
personality and social factors. Bulimics often suffer
from other disorders such as alcohol or drug abuse,
impulsivity and kleptomania.
Bulimia
 It may be triggered by life events such as feeling
guilty or feeling depressed. There is a stronger link
between depression and bulimia compared with
depression and anorexia. The depression seems to
be linked to a deficit in the neurotransmitter
substance serotonin. Bulimics may report lacking
self-confidence and use food to fulfil their feelings
of longing and emptiness. The binge eating and
vomiting is justified in terms of needing to have a
high calorie intake of food and a desire to stay slim.
Bulimia
 Treatment involves medication and cognitive
behavioural therapy. Antidepressants drugs are used
in combination with psychotherapy. Treatment for
bulimia tends to be more successful because
bulimics recognise that they have a problem
whereas anorexics don't.
Health and Poverty
 It is important to point out that the most
damaging lifestyles for our health are those
associated with low incomes. Throughout the
Western world, the most consistent predictor
of illness and early death is income. People
who are unemployed, homeless, or on low
incomes have higher rates of all the major
causes of premature death (Fitzpatrick and
Dollamore, 1999).
Health and Poverty
 The reasons for this are not clear although
there are two main lines of argument. First, it
is possible that people with low incomes
engage in risky behaviours more frequently,
so they might smoke more cigarettes and
drink more alcohol. This argument probably
owes more to negative stereotypes of
working-class people than it does to any
systematic research.
Health and Poverty
 The second line of argument is that poor
people are exposed to greater health risks in
the environment in the form of hazardous
jobs and poor living accommodation. Also,
people on low incomes will probably buy
cheaper foods which have a higher content of
fat (regarded as a risk factor for coronary
heart disease).
Health and Poverty
 All this means that psychological
interventions on behaviour can only have a
limited effect, since it is economic
circumstances that most affect the health of
the nation.
Health and Poverty
 The effects of poverty are long lasting and
far-reaching. A remarkable study by Dorling
et al. (2000) compared late 20th century
death rates in London with modern patterns
of poverty, and also with patterns of poverty
from the late 19th century.
Health and Poverty
 The researchers used information from
Charles Booth’s survey of inner London
carried out in 1896, and matched it to
modern local government records.
Health and Poverty
 When they looked at the recent mortality
(death) rates from diseases that are
commonly associated with poverty (such as
stomach cancer, stroke and lung cancer), they
found that the measures of deprivation from
1896 were even more strongly related to
them than the deprivation measures from the
1990s. They concluded that patterns of
disease must have their roots in the past.
Health and Poverty
 It is remarkable, but true, that geographical
patterns of social deprivation and disease are
so strong that a century of change in inner
London has not disrupted them.
Health and Poverty
 Another study by Dorling et al. (2001)
plotted the mortality ratio (rate of deaths
compared to the national average) against
voting patterns in the 1997 general election.
They divided the constituencies into ten
categories, ranging from those who had the
highest Labour vote to those who had the
lowest.
Health and Poverty
 The analysis found that the constituencies
with the highest Labour vote (72 per cent on
average) had the highest mortality ratio
(127), and that this ratio decreased in line
with the proportion of people voting Labour,
down to the lower Labour vote (22 per cent
on average) where there was a much lower
mortality ratio (84).
Health and Poverty
 This means that early death, and presumably
poor health, was more common in areas that
chose to vote Labour. If we take Labour
voting as still being influenced by class and
social status then this study gives us another
measure of the effects of wealth on health.
Health and Poverty
 The influence of poverty shows up in a
number of ways. Glaucoma is a damaging
eye disease that can cause blindness if
untreated. A study by Fraser et al. (2001)
looked at the differences between people
who sought medical help early (early
presenters) and those who sought help for the
first time when the disease was already quite
advanced (late presenters).
Health and Poverty
 The late presenters were more likely to be in
lower occupational classes, more likely to
have left full-time education at age 14 or
younger, more likely to be tenants than
owner occupiers, and less likely to have
access to a car.
Health and Poverty
 It showed that a persons personal
circumstances and the area they lived in had
an effect on their decision to seek help with
their vision. It also appeared that the disease
developed more quickly in people with low
incomes.
Health and Poverty
 One uncomfortable explanation of the
differences in mortality rates for rich and
poor might be that the poor receive worse
treatment from the NHS. Affluent women
have a higher incidence of breast cancer than
women who are socially deprived, but they
have a better chance of survival.
Health and Poverty
 A study to investigate the care of the breast
cancer patients from the most and least welloff areas in Glasgow was carried out by
Macleod et al. (2000). They looked at
records from hospital and general practice to
evaluate the treatment that was given, the
delay between consultation and treatment,
and the type and frequency of follow-up care.
Health and Poverty
 The data showed that women from the
affluent areas did not receive better care from
the NHS. The women from the deprived
areas received similar treatment, were
admitted to hospital more often for other
conditions than the cancer, and had more
consultations after the treatment than the
women from the affluent areas.
Health and Poverty
 Perhaps the reasons for the worse survival
rate of women from deprived areas are not
related to the quality of care, but to the
number and severity of other diseases that
they have alongside the cancer.
THE TYPE A BEHAVIOUR
PATTERN
 Do some lifestyles make people more vulnerable to
disease? Are we justified, for example, in
associating high stress behaviour with certain health
problems such as heart disease? Friedman and
Rosenman (1959) investigated this and created a
description of behaviour patterns that has generated
a large amount of research and also become part of
the general discussions on health in popular
magazines.
THE TYPE A BEHAVIOUR
PATTERN
 Before we look at the work of Friedman and
Rosenman, it is worth making a
psychological distinction between behaviour
patterns and personality. Textbooks and
articles often refer to the Type A personality,
though, at least in the original paper, the
authors describe it as a behaviour pattern
rather than a personality type.
THE TYPE A BEHAVIOUR
PATTERN
 The difference between these two is that a
personality type is what you are, whereas a
behaviour pattern is what you do. The importance
of this distinction comes in our analysis of why we
behave in a particular way (‘I was made this way’
or ‘I learnt to be this way’), and what can be done
about it. It is easier to change a person’s pattern of
learnt behaviour than it is to change their nature.
THE TYPE A BEHAVIOUR
PATTERN
 Friedman and Rosenman devised a
description of Pattern A behaviour that they
expected to be associated with high levels of
blood cholesterol and hence coronary heart
disease. This description was based on their
previous research and their clinical
experience with patients.
THE TYPE A BEHAVIOUR
PATTERN
 A summary of Pattern A behaviour is given
below:

(1) an intense, sustained drive to achieve
personal (and often poorly defined) goals

(2) a profound tendency and eagerness to
compete in all situations

(3) a persistent desire for recognition and
advancement
THE TYPE A BEHAVIOUR
PATTERN

(4) continuous involvement in several activities
at the same time that are constantly subject to
deadlines

(5) an habitual tendency to rush to finish
activities

(6) extraordinary mental and physical alertness.
THE TYPE A BEHAVIOUR
PATTERN
 Pattern B behaviour, on the other hand, is the
opposite of Pattern A, characterised by the
relative absence of drive, ambition, urgency,
desire to compete, or involvement in
deadlines.
Research into type A
behaviour
 The classic study of Type A and Type B
behaviour patterns was a twelve-year
longitudinal study of over 3,500 healthy
middle-aged men reported by Friedman and
Rosenman in 1974. They found that,
compared to people with the Type B
behaviour pattern, people with the Type A
behaviour pattern were twice as likely to
develop coronary heart disease.
Research into type A
behaviour
 Other researchers found that differences in
the kinds of Type A behaviour correlated
with different kinds of heart disease: angina
sufferers tended to be impatient and
intolerant with others, while those with heart
failure tended to be hurried and rushed,
inflicting the pressures on themselves.
Research into type A
behaviour
 Recent reviews of Type A behaviour suggest
that it is not a useful measure for predicting
whether someone will have a heart attack or
not. Myrtek (2001), for example, looked at a
wide range of studies on this issue and
concluded that measures of Type A and of
hostility were so weakly associated with
coronary heart disease as to make them no
use for prevention or prediction.
Research into type A
behaviour
 The lasting appeal of the Type A behaviour
pattern is its simplicity and plausibility.
Unfortunately, health is rarely that simple
and the interaction of stress with
physiological, psychological, social and
cultural factors cannot be reduced to two
simple behaviour patterns.
RELIGIOSITY AND HEALTH
 In 1921 Lewis Terman started the Terman
Life-Cycle Study looking at the lives of over
1500 people. The sample was recruited from
schools in California after the teachers
identified children who were gifted and had
an IQ of 135 and above. The average year of
birth was 1910 so their age at the start of the
study was 11 years.
RELIGIOSITY AND HEALTH
 It was not a very diverse sample, as they
were mostly selected from white middleclass families, but this apparent weakness is
a strength if we want to look at the effect of
selected variables that do not include
ethnicity and class.
RELIGIOSITY AND HEALTH
 Data was collected over the years and in
1950 (when the participants were aged about
40) they were asked about their religiosity on
a four-point scale (not at all: little: moderate:
strong). Forty years later the researchers
were able to compare this data against the
mortality of the sample.
RELIGIOSITY AND HEALTH
 To cut to the chase, once the researchers had
accounted for all the other variables they
were able to say that people who were more
religious lived longer (Clark et al. 1999).
The end