Health Inequalities

Our work on health inequalities:

The four health behaviours of Diet; Alcohol; Smoking; Physical activity that we research are socially patterned (i.e.) certain behaviours are more likely to occur in specific socio-economic groups.

Here at the BHRU, we seek to establish which interventions have the potential to change behaviour across all socio-economic groups which can potentially help to reduce the socio-economic patterning of behaviour.

Why is this important?

Figures from the Office for National Statistics suggest a gap of 8.6 years between boys born in the area in England and Wales with the highest life expectancy and those born in the area with the lowest life expectancy. The gap for newborn girls is 6.9 years.

Estimates suggest that the gap in life expectancy between the rich and the poor would halve if people stopped smoking, consumed food and alcohol in modest quantities and became more physically active (Di Cesare et al, 2013).

Click on the images below to read more about the work we have been doing in this area:

 Key Studies:

  • Does placing unhealthy snacks further away reduce the likelihood of consumption?

    There is a consistent “proximity effect” for food: people select and consume less food when it is placed further away from them. However, it is not known whether level of self-control impacts on how well the proximity effect works.

    In two studies, we found that people are less likely to take chocolates when they are placed an extra 50cm away. This effect seemed to work similarly regardless of a person’s current level of self-control.

    This shows that placing unhealthy food further away may be a simple but effective way to reduce the likelihood of consuming these snacks.

    Effect of snack-food proximity on intake in general population samples with higher and lower cognitive resource. Hunter, Hollands, Couturier, Marteau, 2018.

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  • Would increasing the price of sugary soft drinks influence purchases of alcohol?

    The UK Government levy on sugary drinks producers began in April 2018, potentially influencing the cost of a large range of non-alcoholic beverages.

    This study looked at how increasing the price of non-alcoholic drinks could influence purchases of alcoholic drinks, such as beer, wine and cider, in supermarkets.

    We found that increasing the price of sugary drinks could increase purchases of lager, while increases in the price of diet drinks could increase purchases of beer, cider and wines.

    Effect of increasing the price of sugar-sweetened beverages on alcoholic beverage purchases: an economic analysis of sales data. Quirmbach, Cornelsen, Jebb, Marteau, Smith, 2018.

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  • Does self-control alter the effectiveness of interventions to change alcohol, tobacco, and food consumption?

    People with lower self-control tend to drink more, smoke more, and eat more unhealthy food. Low self-control might also influence the success of interventions that aim to change these behaviours.

    We conducted a systematic review to assess whether individual differences in self-control influence the effectiveness of interventions to change alcohol, tobacco, and food consumption.

    Our findings show that 22 studies (41%) did not report differences in intervention effectiveness by self-control, 18 (33%) reported interventions to be less effective in those with low self-control, and 14 (26%) reported interventions to be more effective in those with low self-control. This pattern of findings did not differ from chance.

    So, whilst self-control often influenced intervention outcomes, there was no consistent pattern of effects.

    Does self-control modify the impact of interventions to change alcohol, tobacco, and food consumption? A systematic review. Stautz, Zupan, Field, Marteau, 2018

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  • Do cognitive resources in childhood predict teenage behaviour?

    Child head with education iconsCognitive resources encompass abilities including IQ and processes involved in planning, monitoring, and revising goal-directed behaviour (e.g., impulsivity).

    Looking at data from over 6,000 young people in the ALSPAC cohort, we found that:

    – Higher IQ at age 8 predicted having drunk alcohol, not smoking, greater fruit and vegetable consumption, and not being overweight at age 13

    – Higher impulsivity at age 9 predicted having drunk alcohol and smoking at age 13

    – Higher working memory at age 10 predicted not being overweight at age 13

    These were all small effects.

    Our findings suggest that interventions that can improve childhood cognitive resources, such as improving access to enriching environments, education, and financial resources, could have small indirect effects on improving health behaviours. As differences in cognitive resources have been observed between individuals in higher and lower socioeconomic groups, this could potentially also help reduce health inequalities.

    Do Executive Function and Impulsivity Predict Adolescent Health Behaviour after Accounting for Intelligence? Findings from the ALSPAC Cohort. Stautz, Pechey, Couturier, Deary, Marteau, 2016.

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  • Is acting on intentions to change diet socially patterned?

    iStock_000070513897_MediumBringing together data from previous studies, we found no evidence that those from more deprived groups are less likely to act on their intentions to change their behaviour, including changing their diet.

    However, we found some differences between more and less deprived groups in terms of the influence of perceived control over behaviour (self-efficacy) on actual behaviour:

    • for those from less deprived groups, higher perceived control over their behaviour was associated with healthier behaviour;
    • for those from more deprived groups, perceived control over behaviour had no relation to health behaviour.


    This suggests interventions that do not require active engagement from people may be more effective at reducing health inequalities, as responses to these may be less likely to depend on attributes like perceived control over behaviour.

    Is the intention–behaviour gap greater amongst the more deprived? A meta-analysis of five studies on physical activity, diet, and medication adherence in smoking cessation. Vasiljevic, Ng, Griffin, Sutton & Marteau. 2016.

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  • Is shopping in lower-cost supermarkets associated with less healthy purchases?

    Man at supermarket examining a long grocery receipt with shopping cart on foreground.Customers of lower-cost supermarkets tend to purchase less fruit and veg and more unhealthy foods than customers of higher-cost supermarkets.

    However, our study suggests lower-priced supermarkets are unlikely to be disproportionately promoting unhealthy foods or stocking fewer healthier options compared to higher-priced stores.

    Supermarket Choice, Shopping Behavior, Socioeconomic Status, and Food Purchases. Pechey & Monsivais, 2015.

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  • Are more deprived households likely to buy supermarket promotions?

    iStock_000016194323_MediumIn our study which looked at price promotions in stores, we found that people were more likely to purchase less-healthy food items on promotion, rather than healthier items, and that less deprived households were more likely to buy foods on promotion than more deprived households.

    This evidence suggests that whilst policies targeting promotions on less healthy foods might help people to have healthier shopping baskets, they would have little effect on reducing health inequalities caused by deprivation.

    Price promotions on healthier vs. less healthy foods: a hierarchical regression analysis of the impact on sales and social patterning of responses to promotions in Great Britain. Nakamura, Suhrcke, Jebb, Pechey, Almiron-Roig, Marteau, 2015.

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  • Why don’t poor men eat fruit?

    desk in big fruit pileWe looked at whether there were differences by Socioeconomic Status (SES) in how much people liked fruit. We were interested in whether this might explain socioeconomic differences in self-reported fruit consumption.

    Our results showed:

    • no differences between SES found for self-reported liking of fruit, but that
    • lower SES men had lower implicit liking of fruit (as measured by the Implicit Association Task)


    Why don’t poor men eat fruit? Socioeconomic differences in motivations for fruit consumption. Pechey, Monsivais, Ng, Marteau, 2014.

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  • Do deprived households have less healthy shopping baskets?

    Shopping basket with assortment of unhealthy food on white backgroundWe looked at the purchases of 25,000 British households in 2010 to get a detailed picture of socioeconomic differences in the purchases of food and drink and found:

    • that more deprived households purchased a larger proportion of energy from less healthy foods and drinks than less deprived households, and vice versa for healthier foods and drinks.


    This pattern of purchasing could contribute to the health differences we see between socioeconomic groups.

    Socioeconomic differences in purchases of more vs. less healthy foods and beverages: Analysis of over 25,000 British households in 2010. Pechey, Jebb, Kelly, Almiron-Roig, Conde, Nakamura, Shemilt, Suhrcke, Marteau, 2013.

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    Publications related to socio-economic patterning of behaviour: