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Health inequalities have been observed internationally across a number of dimensions (including, eg, socioeconomic position, ethnicity and gender) and have persisted over time.1 The lack of progress in addressing them has disappointed many within public health, particularly given an apparent prioritisation of health inequalities in UK policy.2 Building on recent research highlighting the limitations of addressing health inequalities by trying to change health behaviours of individuals,3 we argue that attempts to tackle health inequalities are impeded by the current framing that dominates much public health policy and research. We suggest some alternative ways forward.
Policy analysts have drawn attention to a recurrent policy emphasis on health behaviours in the UK, despite acknowledgment among decision makers that wider social and economic factors are important.4 This approach has been reinforced by researchers focusing on addressing health inequalities by modifying health behaviours via individual-level interventions, which do not fully take into account the impact of the social and economic environments in which people live over time.5 This preoccupation is illustrated by a recent King's Fund study that reported increasing inequality in what the authors call the ‘clustering of unhealthy behaviours over time’ in England.6 Even when governments commit to addressing social determinants of health, specific actions and interventions often revert to trying to modify individuals’ behaviours. Hilary Graham describes this process as follows:
A recurrent slippage occurs as the policy statements move from overarching principles to strategic objectives, with a broad concept of determinants giving way to a narrower focus on individual risk factors.7
While there is clearly a role for addressing health behaviours as part of efforts to reduce health inequalities, this ‘lifestyle drift’ neglects …
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