lifestyles and health behaviour-1

8/13/2019 Lifestyles and Health Behaviour-1

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Lifestyles and health behaviour

determinants of health-enhancingbehaviours
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What are health behaviours?

Kasl and Cobb (1966) defined three types ofhealth related behaviours. They suggested that;

a health behaviour is a behaviour aimed at preventingdisease (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).


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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).


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Behaviour and mortality

50% of mortality from the 10 leading causes of death isdue to behaviour.

Doll and Peto (1981) estimated that 75% of cancerdeaths were related to behaviour. 90% of all lung cancermortality is attributable to cigarette smoking, which is alsolinked to other illnesses such as cancers of the bladder,

pancreas, mouth, and oesophagus and coronary heartdisease. Bowel cancer is linked to behaviours such as adiet high in total fat, high in meat and low in fibre.


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ifestyle andhealth

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).


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ifestyle andhealth


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Holy Four

Four behaviours in particular are associated withdisease: smoking, alcohol misuse, poor nutrition

and lower levels of exercise; these are called theholy four.

Conversely, rarely eating between meals, sleepingfor seven to eight hours each night, and eating

breakfast nearly every day have been associatedwith good health and longevity (Breslow andEnstrom 1980). Recently high-risk sexual activityhas been added to the risk factor list.


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Belloc and Breslow (1972)

Belloc and Breslow (1972) conducted an

epidemiological study asking a representativesample of 6928 residents of Almeida County,

California whether they engaged in the

following seven health practises:


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Belloc and Breslow (1972)

1. sleeping seven to eight hours daily

2. eating breakfast almost every day

3. never or rarely eating between meals

4. currently being at or near prescribed heightadjusted weight

5. never smoking cigarettes6. moderate or no use of alcohol

7. regular physical activity.


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Positive attitude

Having a positive attitude towards lifehas been found to increase longevity

(Levy et al, 2002).The team used datagathered in 1975 in Oxford, Ohio, wherealmost everybody over 50 wasquestioned about their life and health. By

tracing the deaths of participants over 23years, the team was able to matchlifespan against attitudes towards ageingexpressed at the start.
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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.


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Positive attitude

In theJournal 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.


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Evaluation

There are several methodological criticisms that canbe made of the original study by Belloc andBreslow and the follow-up studies. First, the sampleis not particularly representative as all the

participants came from the same area in the USA.

Second, the study establishes a correlation betweenseven specific health preventive behaviours andlongevity, but does not prove that these behavioursactually caused some of the participants to livelonger. It is possible, although unlikely, that someother factorpersonality, for exampleaffected

both behaviour and lifespan.


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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 stronglythat 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 ifthey do fall ill.


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Evaluation

There have been cases where doctors haverefused to treat certain patients because they

felt that they had brought their illnesses onthemselves. The greatest contributions tohealth have been through developments inmedical science and through public health

initiatives such as improved sanitation, andnot through individual behavioural change.


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Evaluation

The second problem with the behavioural

change approach is the narrow line that

exists between persuading someone tochange 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 forcethem to change their behaviour?


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Genetic theories

Is it possible, however, for apersonsgenetic

inheritance to directly affect their health-

related 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 aremore likely to become alcoholic themselves.


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Genetic theories

Although it is notoriouslydifficult to determine whether

a correlation such as this isdue to genetic factors or arisesas a result of social learning,some psychologists argue that,

although there probably is nosuch thing as an alcoholismgene, certain geneticallyinherited personality traits

may pre-dispose an individualtowards alcohol abuse.


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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 foodpreferences. Fischer and Dyer (1981)reported that family history of obesity wasrelated to increased intake of sweets, dairy

products, and fatty foods in a sample of116 high school girls. Their results alsoindicated that having a family history ofheart problems was related to decreased

consumption of milk, eggs, and saltyfoods.


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dietary risk factors. Levine, Lewy, and New (1976) found a

family history of hypertension to beassociated with a greater prevalence of

obesity among African Americanadolescents. Some investigators havealso analyzed dietary intake among twin

populations as evidence of a genetic

variance for nutrient intake. In one ofthese studies, De Castro (1993) foundsignificant heritabilities for identical andfraternal twins with regard to the

amount of food energy andmacronutrients eaten daily.


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dietary risk factors. In contrast, Fabsitz, Garrison, Feinleib, and

Hjortland (1978) demonstrated that, in addition to a

genetic variance, environmental effects (e.g., howfrequently twins saw each other) were important inaccounting for similarities in twins nutrientintakes. These results suggest that there may be an

interaction between genetic and environmentalfactors that influence eating behaviors amongadolescents.


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Genetic theories

Genetic theoriessuggest that there may be agenetic predisposition to becoming an

alcoholic or a smoker. To examine theinfluences of genetics, researchers haveexamined either identical twins reared apartor the relationship between adoptees and

their biological parents. Thesemethodologies tease apart the separateeffects of environment and genetics.


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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 smokingbehaviour). He reported that 18 pairs were bothnon-smokers and 15 pairs were both smokers. Thisis a much higher rate of concordance than predicted

by chance. Evidence for a genetic factor in smokinghas also been reported by Eysenck (1990) and in anAustralian study examining the role of genetics in

both the uptake of smoking (initiation) and

committed smoking (maintenance) (Murray et al.1985).


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Genetic theories

Research into the role of genetics inalcoholism has been more extensive

and reviews of this literature can befound elsewhere (Peele 1984;Schuckit 1985). However, it has beenestimated that a male child may be

up to four times more likely todevelop alcoholism if he has abiological parent who is an alcoholic.


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Behaviourist learning

theories Classical conditioning is a process in which

the individual associates an automatic

response with a neutral stimulus. Ivan Pavlov(18491936) described this process after henoticed that laboratory dogs would salivate

when he turned a light on because they hadlearnt to associate the light with the presenceof food.


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theories


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theories Classical conditioning could explain certain health-

related behaviours such as comfort eating, for

example. If a parent regularly offers a child sweetsor chocolate at the same time as physical andemotional affection, then the child may learn toassociate sweet foods with the reassuring feelings

that arise out of parental love. In later life, the childmay try to recreate these pleasant feelings by eatingchocolate when he or she is stressed or depressed.


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theories


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Operant conditioning

Operant conditioning is when people respond to

reward or punishment by either repeating a

particular behaviour, or else stopping it. If anindividual 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.


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A striking example of how operant conditioning canaffect health behaviour is the study by Gil et al

(1988). They conducted research on childrensuffering from a chronic skin disorder that causessevere itching. They videotaped the children withtheir parents in the hospital and observed that when

parents tried to stop their children scratching (inorder to prevent peeling and infection) this actuallyincreased the scratching behaviour by rewarding itwith attention.


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When they asked parents to ignore their childrenwhen they scratched and give them positive

attention when they did not scratch, the amount ofscratching was significantly reduced.

Drinking, eating, smoking, drug and sexualaddictions all have the irrationalcharacteristic that

the total amount of pleasure gained from theaddiction seems much less than the suffering caused

by it. According to learning theorists, the reason forthis lies in the nature of the gradient of

reinforcement.


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Addictive behaviours are typically those inwhich pleasurable effects occur rapidly after

the addictive behaviour while unpleasantconsequences occur after a delay. The simplemechanism of operant conditioning and the

gradient of reinforcement is able, as it were,to overpower the mindscapacity for rationalcalculation.


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Social learning

Social learning occurs when an individual

observes and imitates another persons

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 beingrewarded for his or her actions.


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Social learning

Social learning can clearly be very influentialin encouraging people to do things that are

bad for their health (for example, a teenagermay take up smoking because he or she hasan admired elder brother who smokes, or

may try illegal drugs because he or she seesother people taking them and having a goodtime).


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Social learning

Another example of how vicarious reinforcement can lead tounhealthy behaviour concerns young women with eatingdisorders, who see images of very thin models in magazines

being rewarded with success, money, glamour and fame. Onthe other hand, many health promotion campaigns use

positive role models to try to get people to lead healthierlifestyles. The advertising industry, whose reason for

existing is to persuade people to change their behaviour,often depicts successful, good-looking and happy peopleusing a certain product in the hope that this will make others

want to use the product as well.


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Social learning


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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

ones ability to carry out ones plans successfully.

People with lower self-efficacy are much more

likely to imitate undesirable behaviours than those

with higher self-efficacy.


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self-efficacy

Heather and Robertson (1997) give a usefuldiscussion of the application of these principles to

drinking. Patterns of drinking by parents areobserved by children who may then imitate them inlater life, especially the behaviour of the same sex

parents. In adolescence, the drinking behaviour of

respected older peers may also be imitated, andsubsequently that of higher status colleagues atwork, a phenomena, which may explain the

prevalence of heavy drinking in certain professionssuch as medicine and journalism.


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Commentary

Many psychologists criticize behaviourist-learning theories on the grounds that they are

too mechanistic. In other words, theyassume that human beings respondautomatically to specific situations. Not onlydoes this imply a lack of freewill, but also italso ignores the effect on behaviour ofcognitive factors.


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Social and environmental

factors There are many different social and environmental

factors contributing to peoples health behaviour.

For example, a common explanation for youngpeople 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.


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factors Social factors such as culture influence

dietary behaviour. Culture affects an

individuals food selection, preparation, andeating patterns. Certain tastes or food areassociated with specific feelings andmeanings within a culture (for example, soulfood may denote fried and barbecue meatswithin the African American community).


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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).


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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 foundthat childrens television viewing positivelycorrelates with smoking behaviour and attempts to

influence parents shopping selections (Dietz andGortmaker, 1985). Television viewing is alsohighly correlated with obesity in children (Bowen etal, 1991).


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Commentary

Conformity does not exert an equallystrong influence in all situations and with

all individuals, It is likely to be morepowerful in ambiguous situations, whenothers are perceived as having moreexpertise, or when the individual has lowself-confidence, poor self-esteem and aweak sense of self-efficacy.


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High-risk sexual behaviour

Hawkins et al. (1995) reported that the mostfrequent safer sex behaviour amongst well-educated

heterosexual students was the use of thecontraceptive pill. The least frequent sexual

practice, reported by only 24% of the sample, wasthe use of condoms. An important factor is that the

majority of young persons do not see themselves asat risk of HIV infection or have feelings ofinvulnerability towards the disease.


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Exercise

Those who are physically active throughout the adultlife live longer than those who are sedentary.

Paffenburger et al (1986) monitored leisure timeactivity in a cohort of 17000 Harvard graduatesdating back to 1916. Using questionnaires it wasfound that those who were least active after

graduation had a 64% increased risk of heart attackcompared with their more energetic classmates.Those who expended more than 2000 calories ofenergy in active leisure activities per week lived, onaverage, two and a half years longer than thoseclassified as inactive.


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Exercise

About a quarter of the UK population engage in healthpromoting levels of exercise, with a similar picture

in the USA. In recent years these levels havedramatically increased. For example in Wales 20%of men and 2% of women took sufficient exercisein 1985 but by 1990 this had increased to 27% of

the population. Those who engage in exercise aremore likely to be young, male and well-educatedadults, members of higher socio-economic groups,and those who have exercised in the past.


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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 consequenceof 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.


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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.


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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.


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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 muscleendurance (Pipes and Wilmore, 1975).


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4. Anaerobic exercise involves short, intensive

bursts of energy without an increased amount of

oxygen such as in short distance running. Suchexercises 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.


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5. Aerobic exercise requires dramatically increasedoxygen consumption over an extended period of

time such as in jogging, walking, dancing, ropeskipping, swimming and cycling. The heart ratemust be in a certain range which is computedfrom a formula based on age and the maximum

possible heart rate. The heart rate should stay atthis elevated level for at least 12 minutes, andpreferably 15 to 30 minutes. This exerciseimproves the respiratory system and the coronarysystem.


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Organic & Dynamic Fitness

Kuntzleman (1978)

Organic fitness-our capacity for action andmovement determined by inherent factors

such as genes, age and health status.

Dynamic fitness-determined by our

experience.


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London bus crews

Maurice et al. (1953)studied London double

decker bus drivers andtheir conductors. Themore active conductorshad significantly less

incidence of C. H. D.than did the sedentarydrivers. Can you thinkof any confoundingfactors in this study?


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Exercise

Exercise has been found to lower depressivemoods in a variety of people, including

young pregnant women from ethnicallydiverse backgrounds (Koniak-Griffin, 1994)and nursing home residents aged 66 to 97(Ruuskanen and Parkatti, 1994). Thesefindings could be due to the release ofendogenous Opiates during exercise.


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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 killercell activity and an increase in the percentage of T-

cells (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.


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Exercise

Both exercise and stress reduce adrenaline andother hormones yet exercise has a beneficial effect

on heart functioning whereas stress may producelesions in heart tissue. In exercise adrenalinemetabolises differently and is released infrequentlyand gradually under conditions for which it was

intended (e.g. jogging). In conditions of stressadrenaline is discharged in a chronic and enhancedmanner.


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ietary 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 wasfound 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.


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ietary habits A 24 year longitudinal study of American

men working for western electricity found

that men who consumed high levels ofcholesterol were twice as likely to developlung cancer compared with men whoconsumed low levels of cholesterol. Much ofthe cholesterol came from eggs (Shekelle etal, 1991).


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ietary habits High fibre diets protect men and women

from cancer of the colon and the rectum.

Fibre from fruits and vegetables offer moreprotection against colon cancer than thatfrom cereals and other grains. Fruitconsumption offers protection against lungcancer and we should be eating fruit 3 to 7times per week (Fraser et al, 1991).


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Obesity and eating disorders

More than a quarter of children in Englishsecondary schools are clinically obese,

almost double the proportion a decadeago, and an official survey released in

April 2006 also showed that girls weresuffering more than boys from a crispand chocolate-fuelled life of too mucheating and too little exercise.


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Researchers measured the height andweight of 11-15 year olds, and found

26.7% of girls and 24.2% of boysqualified as obese - nearly double therate in 1995. Among children aged 2-10,12.8% of girls and 15.9% of boysweighed above the obesity threshold -also well up on 10 years before.


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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 to26.7%.


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The survey also found that the obesityrate among adults had risen to 24%, in

spite of people exercising more andeating more fruit and vegetables.

However, more men gave up smoking

than women, and in 2004 there were forthe first time more women smokers(23%) than there were men (22%).


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Obesity is defined in terms of the percentageand distribution of an individual's body fat.

Techniques used to assess the body fat rangefrom using computer tomography (e.g.ultrasound waves) to magnetic resonanceimaging (MRI). Obesity may also be defined interms of body mass index (B. M. I.) which iscalculated by dividing a person's weight bytheir height squared using metric units (i.e.kilogrammes and metres squared).


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Stunkarda (1984) suggested that obesityshould be categorised as either mild (20

to 40% overweight), moderate (41 to100% overweight) or severe (more than100% overweight). This would suggestthat 24% of American men and 27% of

American women are at least mildlyobese (Kuczmarski, 1992).


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Obesity

There are three different types of theories thatattempt to explain obesity; they are:

1. Physiologicaltheories suggesting that there are geneticelements.

2. Metabolic ratetheories proposing that obese peoplehave a lower resting metabolic rate, burn up less calorieswhen resting and therefore require less food. They also

tend to have more fat cells which are geneticallydetermined.

3. Behaviouraltheories suggest that obese people tend tobe less physically active and eat more food than required.


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Eating disorders

The two main eating disorders are anorexia

nervosaand bulimia.


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Anorexia

Individuals are diagnosed as anorexic only if they weigh atleast 15% less than their minimal normal weight and havestopped menstruating. In extreme cases, anorexics may

weight less than 50% of their normal weight. Weight lossleads to a number of potentially dangerous side-effects,including emaciation (wasting of the body), susceptibility toinfection and other symptoms of under nourishment.Females are 20 times more likely to develop anorexia thanmales. But horseracing Jockeys, who are usually male, aresusceptible to anorexia. Anorexia particularly affects white,Western, middle to upper class, teenage women.


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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.


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Anorexia

American undergraduates were shown figures oftheir own sex and asked to indicate the figure that

looked most like their own shape, their ideal figureand the figure they found would be most attractiveto the opposite sex. Men selected very similarfigures for all three body shapes! Women choseideal and attractive body shapes that were muchthinner than the shape that was indicated asrepresenting their current shape. Women tended tochoose thinner body shapes for all three choices(ideal, attractive and current) compared to the men

(Fallon and Rozin, 1985).


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Anorexia

The perfect figure has changed over the

years. In the 1950s female sex symbols had

much larger bodies compared with present-

day female sex symbols.


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Anorexia

The hypothalamus is implicated in anorexia.

The hypothalamus controls both eating and

hormonal functions (which may also explain

irregularities in menstruation).


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Anorexia

Personality factors and family dynamics could alsoplay a part in anorexia. The anorexic lacks self-

confidence, needs approval, is conscientious, is aperfectionist and feels the pressure to succeed(Taylor, 1995).

Parental psychopathology or alcoholism also plays

a part as does being in an extremely close orinterdependent family with poor skills forcommunicating emotion or dealing with conflict(Rakoff, 1983).


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Anorexia

The mother daughter relationship has been

implicated. Mothers of anorexic daughters tend to

be dissatisfied with their daughter's appearance andtend 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
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Bulimia

Bulimia is characterised by recurrent episodes ofbinge eating followed by attempts to purge theexcess eating by vomiting or using laxatives. The

binges occur at least once a day usually in theevening and when alone. Vomiting and the use of

laxatives disrupts the balance of the electrolytepotassium resulting in dehydration, cardiacarrhythmias and urinary infections.


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Bulimia

This disorder mainly affects young women and ismore common than anorexia affecting five to ten%of American women. Bulimia is not confined tomiddle or upper-class females and transcends racial,ethnic and socioeconomic boundaries. Like

anorexia explanations encompass biological,personality and social factors. Bulimics often sufferfrom other disorders such as alcohol or drug abuse,impulsivity and kleptomania.


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Bulimia

It may be triggered by life events such as feelingguilty or feeling depressed. There is a stronger link

between depression and bulimia compared withdepression and anorexia. The depression seems to

be linked to a deficit in the neurotransmitter

substance serotonin. Bulimics may report lackingself-confidence and use food to fulfil their feelingsof longing and emptiness. The binge eating andvomiting is justified in terms of needing to have a

high calorie intake of food and a desire to stay slim.


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Bulimia

Treatment involves medication and cognitivebehavioural therapy. Antidepressants drugs are usedin combination with psychotherapy. Treatment for

bulimia tends to be more successful becausebulimics recognise that they have a problem

whereas anorexics don't.


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Health and Poverty

It is important to point out that the most

damaging lifestyles for our health are those

associated with low incomes. Throughout theWestern world, the most consistent predictor

of illness and early death is income. People

who are unemployed, homeless, or on lowincomes have higher rates of all the major

causes of premature death (Fitzpatrick and

Dollamore, 1999).


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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 incomesengage in risky behaviours more frequently,

so they might smoke more cigarettes and

drink more alcohol. This argument probablyowes more to negative stereotypes of

working-class people than it does to any

systematic research.


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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 hazardousjobs and poor living accommodation. Also,

people on low incomes will probably buy

cheaper foods which have a higher content offat (regarded as a risk factor for coronary

heart disease).


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Health and Poverty

All this means that psychological

interventions on behaviour can only have a

limited effect, since it is economiccircumstances that most affect the health of

the nation.


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Health and Poverty

The effects of poverty are long lasting and

far-reaching. A remarkable study by Dorling

et al. (2000) compared late 20th centurydeath rates in London with modern patterns

of poverty, and also with patterns of poverty

from the late 19th century.


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Health and Poverty

The researchers used information from

Charles Booths survey of inner London

carried out in 1896, and matched it tomodern local government records.


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Health and Poverty

When they looked at the recent mortality

(death) rates from diseases that are

commonly associated with poverty (such asstomach cancer, stroke and lung cancer), they

found that the measures of deprivation from

1896 were even more strongly related tothem than the deprivation measures from the

1990s. They concluded that patterns of

disease must have their roots in the past.


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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 innerLondon has not disrupted them.


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Health and Poverty

Another study by Dorling et al. (2001)

plotted the mortality ratio (rate of deaths

compared to the national average) againstvoting patterns in the 1997 general election.

They divided the constituencies into ten

categories, ranging from those who had thehighest Labour vote to those who had the

lowest.


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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 centon average) where there was a much lower

mortality ratio (84).


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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 Labourvoting as still being influenced by class and

social status then this study gives us another

measure of the effects of wealth on health.


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Health and Poverty

The influence of poverty shows up in a

number of ways. Glaucoma is a damaging

eye disease that can cause blindness ifuntreated. A study by Fraser et al. (2001)

looked at the differences between people

who sought medical help early (earlypresenters) and those who sought help for the

first time when the disease was already quite

advanced (late presenters).


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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 oryounger, more likely to be tenants than

owner occupiers, and less likely to have

access to a car.


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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 withtheir vision. It also appeared that the disease

developed more quickly in people with low

incomes.


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Health and Poverty

One uncomfortable explanation of the

differences in mortality rates for rich and

poor might be that the poor receive worsetreatment from the NHS. Affluent women

have a higher incidence of breast cancer than

women who are socially deprived, but theyhave a better chance of survival.


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Health and Poverty

A study to investigate the care of the breast

cancer patients from the most and least well-

off areas in Glasgow was carried out byMacleod et al. (2000). They looked at

records from hospital and general practice to

evaluate the treatment that was given, thedelay between consultation and treatment,

and the type and frequency of follow-up care.


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Health and Poverty

The data showed that women from the

affluent areas did not receive better care from

the NHS. The women from the deprivedareas received similar treatment, were

admitted to hospital more often for other

conditions than the cancer, and had moreconsultations after the treatment than the

women from the affluent areas.


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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 thenumber and severity of other diseases that

they have alongside the cancer.

THE TYPE A BEHAVIOUR


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THE TYPE A BEHAVIOURPATTERN

Do some lifestyles make people more vulnerable to

disease? Are we justified, for example, in

associating high stress behaviour with certain healthproblems 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 ofthe general discussions on health in popular

magazines.



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Before we look at the work of Friedman and

Rosenman, it is worth making a

psychological distinction between behaviourpatterns and personality. Textbooks and

articles often refer to the Type A personality,

though, at least in the original paper, theauthors describe it as a behaviour pattern

rather than a personality type.



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The difference between these two is that a

personality type is what you are, whereas a

behaviour pattern is what you do. The importanceof 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 persons pattern oflearnt behaviour than it is to change their nature.



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Friedman and Rosenman devised a

description of Pattern A behaviour that they

expected to be associated with high levels ofblood cholesterol and hence coronary heart

disease. This description was based on their

previous research and their clinicalexperience with patients.



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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



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(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.



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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


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Research into type Abehaviour

The classic study of Type A and Type B

behaviour patterns was a twelve-year

longitudinal study of over 3,500 healthymiddle-aged men reported by Friedman and

Rosenman in 1974. They found that,

compared to people with the Type Bbehaviour pattern, people with the Type A

behaviour pattern were twice as likely to

develop coronary heart disease



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Other researchers found that differences in

the kinds of Type A behaviour correlated

with different kinds of heart disease: anginasufferers tended to be impatient and

intolerant with others, while those with heart

failure tended to be hurried and rushed,inflicting the pressures on themselves.



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Recent reviews of Type A behaviour suggest

that it is not a useful measure for predicting

whether someone will have a heart attack ornot. Myrtek (2001), for example, looked at a

wide range of studies on this issue and

concluded that measures of Type A and ofhostility were so weakly associated with

coronary heart disease as to make them no

use for prevention or prediction



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The lasting appeal of the Type A behaviour

pattern is its simplicity and plausibility.

Unfortunately, health is rarely that simpleand the interaction of stress with

physiological, psychological, social and

cultural factors cannot be reduced to twosimple behaviour patterns.


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RELIGIOSITY AND


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RELIGIOSITY ANDHEALTH

It was not a very diverse sample, as they

were mostly selected from white middle-

class families, but this apparent weakness isa strength if we want to look at the effect of

selected variables that do not include

ethnicity and class.

RELIGIOSITY AND


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Data was collected over the years and in

1950 (when the participants were aged about

40) they were asked about their religiosity ona four-point scale (not at all: little: moderate:

strong). Forty years later the researchers

were able to compare this data against themortality of the sample.

RELIGIOSITY AND


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To cut to the chase, once the researchers had

accounted for all the other variables they

were able to say that people who were morereligious lived longer (Clark et al. 1999).

Th d


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The end

lifestyles and health behaviour-1

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