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Public opinion on the determinants of and responsibility for health Findings from questions commissioned by the Health Foundation in the British Social Attitudes Survey 2017

25 January 2019

About 4 mins to read
  • Erica Holt-White

As we approach the end of January, I wonder how many of us have managed to stick to our new year’s resolutions? Health-related resolutions are popular choices, from taking up a new sport to eating better. While it is great that people want to be healthier, it may not be as simple as setting a personal goal – eating healthily is easier if you can access affordable healthy food, and doing more exercise requires a work–life balance that allows you to.

Health care and individual choice tend to dominate discussions about health, as we’ve seen with coverage of The NHS Long Term Plan  and Public Health England’s New Year sugar consumption reduction drive . Yet the majority of our health is actually driven by wider social and economic factors – the social determinants of health.

To understand more about people’s perceptions of what makes us healthy, we funded several questions in the 2017 wave of NatCen Social Research’s British Social Attitudes survey. How important do people think social determinants are relative to health care? And where do they think responsibility for a person’s health lies – with people themselves, or with the government?

What affects our health?

Consistent with political and media discourse, 96% of respondents considered ‘free health care’ to have a ‘very large’ or ‘quite large’ impact on health. ‘Individual behaviours’ was close behind (93%). Less expected was the extent to which respondents recognised the importance of social determinants: over 85% thought ‘support from family and friends’ and ‘area safety and quality’ were important, and at least 70% of respondents gave importance to all the other factors.

However, respondents gave far greater weight to ‘free health care’ and ‘individual behaviours’, with 73% and 59% respectively thinking these had a ‘very large’ impact on health. Far fewer (24%) said the same for wider determinants like education, although people with poorer self-reported health tended to give greater relative weight to social determinants. This shows there is a large difference between what people think is most important for their health and what actually drives it.

Such results may stem from placing greater weight on factors that are seen to have more immediate relevance when a health problem occurs, such as health care, and less on those that help to maintain health throughout life, such as work and education.

Responsibility for health

While many people considered social determinants to be important to health, most (61%) thought individuals have a greater responsibility for their own health than the government. Only a small minority (9%) thought the government has a greater responsibility than individuals. Differences between sub-groups tended to be small, although there is some indication that younger people and those with poorer health see a greater role for the government (36% of respondents over 75 thought individuals are entirely responsible for their health, compared with 9% of 18- to 24-year-olds). Nevertheless, individual responsibility dominated people’s thinking.

The trend is most striking when comparing responses by reported political identification. There was a typical split along party lines when asked whether the government should re-distribute income: 56% of Labour supporters agreed compared with 25% of Conservative supporters. There was more similarity on whether individuals are more responsible for their health than the government: 55% of Labour supporters and 69% of Conservative supporters agreed.

Thinking differently about health

While our health is not entirely down to the government, a focus on individual choice overlooks the role played by the environment in which we live. Many drivers of health are outside individual control and the choices we make are often constrained.

Such strong public views on the importance of individual responsibility are therefore a concern, given the extent to which public opinion can drive policy choices – government’s decision to prioritise spending on the NHS over other areas of provision being a clear example.

As the chapter of the 2018 Chief Medical Officer’s report  that was authored by the Health Foundation sets out, people need access to affordable healthy food and places to exercise, like parks or gyms, and be supported by well-planned transport networks. Ongoing cuts to local services – including transport – exacerbate the situation.

To improve both the public’s and policymakers’ recognition of the social determinants of health, we are working with the FrameWorks Institute to change the way we communicate with the public and media about them. By doing this, we can improve understanding of health inequalities and the support for social interventions to address them. Only then can real change bring about an environment that facilitates healthy lives for everyone.

So, if you’re struggling to keep to your healthy resolutions this year, don’t be too hard on yourself – it’s not down to you alone. Policymakers, institutions, firms, and central and local governments have their role to play too!

Erica Holt-White is an Analyst Intern in the Healthy Lives team at the Health Foundation

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