The 2017 British Social Attitudes survey showed that people believe their health is most strongly influenced by two things: their individual behaviours, and their ability to access health care.
They place less importance on the other determinants of health such as education, employment status, social support and where they live. And almost a third think individuals are entirely responsible for their own health.
Extensive research has shown that differences in social and economic circumstances lead to deeper inequalities in health outcomes. But this is rarely acknowledged in public or media debate. Instead it’s far more common to read headlines about stretched NHS services, or how things like diet, exercise and smoking affect our health as individuals.
Understanding public thinking on health
The headlines reflect and reinforce an individualistic understanding of health, locating the causes of and solutions to health issues entirely in people’s choices and behaviours, and rarely mentioning issues of health inequality.
In a recent blog, President of the ADPH, Jeanelle de Gruchy, says this individualistic way of thinking about health isn’t surprising considering the language health professionals use when talking about prevention.
‘…it’s still all too normal for public health professionals to uncritically use the term ‘lifestyles’. And despite the evidence we continue to situate solutions in individuals and interventions to change their ‘lifestyle choices’.’
This, she says, does two things: ‘…it puts emphasis on the individual, framing health-harming behaviour as individual choice so that secondly, it takes the focus away from the socio-economic determinants of health and from the health inequalities experienced by groups of people.’
Why does it matter?
This is important, because it means we’re not helping the public to understand the wider range of factors that influence whether our lives are healthy or not. And this in turn makes it easier for the government to miss opportunities to protect and enhance health.
It means that deep cuts might be made to public spending in areas like housing, welfare and education, without a public conversation about how this will impact on the long-term health of the country. It also means that while public opinion supports spending more on the NHS, the government has been able to cut public health budgets over recent years.
Social awareness does drive change. Just look at our growing awareness of the plastic waste problem in our oceans, and how that is now affecting consumer behaviour and putting pressure on the government to take action. So how we frame and communicate about issues around public health is important.
A wider language problem
Andy Turner, Public Health Specialty Registrar, takes things one step further in his blog, arguing that the public health sector has a language problem. From its overuse of jargon and management speak, to its inability to communicate the importance of public health to the people it needs to influence.
‘Normal people having normal conversations don’t say ‘risk factor’ or ‘morbidity’, do they? … Real life humans don’t use these words… No wonder we’re struggling to sell the importance of public health’, he says.
Andy even questions use of the term ‘social determinants’, ‘the Big Idea that underlies pretty much everything we do in public health.’ He argues that it needs too much explaining and quotes Pritpal S Tamber who says he is increasingly using ‘social circumstances’ as a term that makes more sense.
Getting to grips with the communication challenges
The Health Foundation is currently working with the FrameWorks Institute to develop a deeper appreciation of the ways in which people understand and think about health, to develop more effective approaches to communicating evidence.
Our recent briefing explores how people think about what makes them healthy. It identifies four main communication challenges that can act as barriers to wider public acceptance of the evidence on the social determinants of health, including:
- broadening what is understood by the term health
- increasing understanding of the role of the social determinants of health
- increasing understanding of how social and economic inequalities drive health inequalities
- generating an understanding of the policy action needed to keep people healthy.
Simple changes we can make now
The next stage of our work with the FrameWorks Institute will develop and test strategies to address these challenges.
In the meantime, the briefing suggests general guidance to bear in mind when communicating to the public around prevention and health issues. This includes:
- Beware of gesturing towards the importance of individual choice or responsibility.
- Avoid ‘crisis messaging’ as this can backfire by reinforcing people’s sense of fatalism and encouraging disengagement.
- Use step-by-step, causal explanations of how social determinants affect health, and provide concrete examples to help deepen the public’s understanding.
And perhaps the easiest change is to be aware of the language we use in our everyday communications and to prioritise speaking plainly about these important issues.
As Andy Turner puts it: ‘Use plain English, even if it’s not quite what we mean. ‘Social circumstances’ and ‘fairness’ might not capture the full meaning of ‘social determinants’ and ‘inequity’ but it’s better to be mostly understood than barely understood.’
Find out more about the work by the FrameWorks Institute and the Health Foundation or get involved by emailing Rachel.Cresswell@health.org.uk.
This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.