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Behavioural determinants of health and disease 

Behavioural determinants of health and disease
Chapter:
Behavioural determinants of health and disease
Author(s):

Lawrence W. Green

and Robert A. Hiatt

DOI:
10.1093/med/9780199218707.003.0007
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date: 06 December 2019

That behaviour is associated with health and disease has never been in doubt. Indeed, the tendency to blame sinful, negligent, indulgent, ignorant, reckless, or selfish behaviour for health problems has too often placed undue emphasis on individual responsibility and culpability when the solution to health problems of populations demanded attention to the social and physical environment. But no matter how behaviour is framed or moralized in relation to its causes, it remains an inescapable variable in the pathway between ultimate upstream aetiologies and the incidence or prevalence of most diseases and health conditions downstream. Approaches to public health have sought throughout the history of civilization (1) to control or cajole the health-related behaviour of individuals, (2) to protect individuals from the behaviour of others, and (3) to mobilize the behaviour of groups to influence health-related social and physical environments.

This chapter reviews the ways in which behaviour relates to the spectrum of health and disease determinants, from environmental to genetic, in shaping health outcomes. It builds on the previous chapters in recognizing the powerful influence of socioeconomic factors, especially poverty, in influencing both behaviour and health. Many commentaries in the past two decades have attempted to correct the early overemphasis on behavioural determinants of health by discounting and sometimes disparaging any focus on individual behaviour in disease prevention and health promotion. This chapter seeks a middle ground, building on the growing understanding of the ecological context of the behaviour–health relationship. It seeks to integrate that knowledge in an approach to public health that acknowledges the reciprocal determinism of behavioural, environmental, and biologic determinants rather than minimizing the importance of behaviour in these complex interactions.

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