Behavioural determinants of health: individual versus societal responsibility

Samuel P Trethewey; Ella KM Reynolds; Christopher S Trethewey

doi:10.3399/bjgp21X716237

Nunan et al draw our attention to the emphasis of so-called ‘lifestyle medicine’ on behavioural determinants of health and the responsibility of individuals for behaviour modification.¹ While it is important to address the leading behavioural determinants of premature mortality in England, namely tobacco use/unhealthy diet/alcohol and drug use/physical inactivity,² the authors rightly highlight the importance of considering the wider determinants of health.

An important point being made here is that overemphasis on health behaviours and individual-focused interventions (intentional or unintentional) may actually increase health inequalities and draw attention away from the main drivers of poor health, namely the wider socioeconomic and environmental determinants of health. As the Marmot reviews have shown us, differences in socioeconomic status are associated with dramatic differences in rates of premature mortality and disability; the 2020 review reported a 12-year difference in healthy life expectancy at birth between the most and least deprived regions of England.³ Moreover, a recent cross-sectional study of 2.5 million premature deaths in England found that one-third of these deaths were attributable to socioeconomic inequality.⁴

Clearly, a balance must be struck between individual responsibility and wider societal/governmental responsibility. It is important not to minimise individual responsibility for one’s own health or create a false dichotomy between individual responsibility and societal responsibility; both are important and should be advocated for simultaneously. Nunan et al provide a useful framework regarding ways to integrate ‘individual-level interventions’ with ‘public health interventions’ to address key modifiable risk factors. In doing so, the authors remind us of the importance of national policy in improving the nation’s health and reducing health inequalities, by placing some of the responsibility at the feet of governments and national public health organisations.

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