Why behavioural health promotion endures despite its failure to reduce health inequities

TLDR

Rising chronic disease rates have led governments to focus on behavior change strategies such as smoking cessation, diet, and physical activity, yet these policies often ignore social determinants that drive health disparities. The authors examine why behavioral health promotion fails to address social inequities and explain why governments still favor such approaches despite mounting evidence of their inadequacy. The paper advocates targeting social determinants to reduce inequities, noting that evidence alone is insufficient and that political will and civil society pressure are essential for equitable health policies.

Abstract

Abstract Increasing rates of chronic conditions have resulted in governments targeting health behaviour such as smoking, eating high‐fat diets, or physical inactivity known to increase risk for these conditions. In the process, many have become preoccupied with disease prevention policies focused excessively and narrowly on behavioural health‐promotion strategies. These aim to improve health status by persuading individuals to change their health behaviour. At the same time, health promotion policy often fails to incorporate an understanding of the social determinants of health, which recognises that health behaviour itself is greatly influenced by peoples’ environmental, socioeconomic and cultural settings, and that chronic diseases and health behaviour such as smoking are more prevalent among the socially or economically disadvantaged. We identify several reasons why behavioural forms of health promotion are inadequate for addressing social inequities in health and point to a dilemma that, despite these inadequacies and increasing evidence of the social determinants of health, behavioural approaches and policies have strong appeal to governments. In conclusion, the article promotes strategies addressing social determinants that are likely to reduce health inequities. The article also concludes that evidence alone will not result in health policies aimed at equity and that political values and will, and the pressure of civil society are also crucial.