Stress Paradigm and Stigma Some public health messages have been so successful it now seems illogical to argue that people engage in ‘unhealthy’ behaviours simply because they are unaware these are likely to impair their health. Think about it, you would be hard pressed to find a smoker who does not know the health risks associated with lighting up and similarly; who out there now is genuinely unaware that eating fruit and vegetables and being physically active is considered to be better for you than eating a high fat diet and being inactive? Despite this common knowledge lots of people still engage in what are considered to be unhealthy behaviours. So we must ask ourselves, why? Research consistently demonstrates that those most likely to follow health advice by conforming to a ‘healthy lifestyle’ are from the more affluent sections of society. In contrast, those most likely to adopt behaviours which have been shown to have detrimental health effects, and least likely to adopt behaviours that promote health, tend to be from less affluent sections of society. Therefore, it seems logical to assume that there is a link between wealth and a person’s capacity to adopt a healthy lifestyle. One theory that has been put forward is the ‘stress paradigm’. This theory explains how people use ‘unhealthy’ behaviours to cope with the circumstances of their lives. For example, mothers living on council estates are known to smoke cigarettes as a way to calm themselves and relax; many people who feel incapable of dealing with the challenges they face turn to drink; while many more may find themselves commonly referred to as ‘comfort eaters’. The stress paradigm suggests that rather than people engaging in these behaviours due to a lack of knowledge or willpower they either consciously or unconsciously use them as a way to combat the trying circumstances they find themselves in. This is one of the many reasons why it is problematic to use stigma as a public health strategy for discouraging particular behaviours. Very often public health messages moralise behaviours in order to stigmatise some while praise others. Sometimes stigma may be legitimately used, e.g., to discourage drink driving. However, very often it can act as a form of victim blaming and actually make it more difficult for individuals to change their behaviour. The government health campaign Change4Life is a case in point. Being inactive is framed as lazy while eating in ways considered to be unhealthy is framed as gluttonous and greedy. Therefore, being seen to be obese comes to signify a bad citizen who is lacking moral fibre. What is not acknowledged in these messages is how social inequality contributes to the occurrence of these behaviours and thus leads to fewer people from less affluent sections of society leading healthy lifestyles. This stigmatisation can however have a damaging psychological impact which adds to the stresses people from these backgrounds already have to cope with. For example, think about someone who feels too ashamed of their body to go swimming and may instead turn to comfort eating to deal with their sense of shame. In this sense, indiscriminately stigmatising health behaviours could itself be considered a public health problem. WARNING: being made to feel bad about yourself and receiving an insufficient amount of support in order to change your behaviour is bad for your health. This supports the argument that the most effective way to combat health inequalities would be to make society more equal. This would relieve people from many of the stresses associated with life experiences that tend to accompany being relatively deprived in a severely unequal society. If current levels of inequality remain then it is unlikely that health interventions aiming to encourage people from less affluent sections of society to adopt ‘healthy lifestyles’ will be effective. This is because the circumstances that make their lives stressful will remain unchanged. Therefore, we must advocate for reducing existing inequalities AND supporting the relatively less affluent sections of society to act on health advice.
DEADLINE: 29/1/16
CONTACT OLI: o.s.williams@bath.ac.uk