Why do health inequalities exist?

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Description: Clear health inequalities exist within countries, with the consequence that more advantaged individuals tend to live longer than disadvantaged individuals. This difference in lifespans appears partially driven by differences in behaviour, in that more advantaged people tend to adopt healthier lifestyles (less smoking, more exercise, healthier diets) than disadvantaged individuals. But what explains these differences in behaviour? An evolutionary perspective predicts that variation in environmental factors will cause variation in behaviour. With respect to health inequalities, the evolutionary framework of life history theory can be used to predict that, in ‘harsh’ environments (such as those experienced by disadvantaged individuals), behaviour will shift to become more present-oriented and less focused on the future; whereas in more ‘benign’ environments (such as those experienced by advantaged individuals), individuals will be more likely to prioritise health in long-term rather than the present. (Note that this evolutionary perspective requires no differences in genetic make-up between groups). Evidence will be presented during this talk to show that the predicted differences in behaviour are seen in environments of more or less ‘harshness’ in the UK. This evolutionary perspective results in a compassionate approach to public health which focuses on changing features of the environment, rather than on individual behaviour change, as the solution to public health concerns. Such public health approaches which focus on environmental change have been described as ‘Jedi public health’ by the sociologist Arline Geronimus.

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