To what extent do social and structural factors influence health-related lifestyles?

Health-related lifestyle according to WHO is a way of living that brings down the risk of being seriously ill or dying early (Europe, 2018). These lifestyles include eating healthy diets, exercising regularly (Fock and Khoo, 2013), avoiding smoking, sleeping well (Abolfotouh et al, 2007) and practising safe sex (Kwan et al, 2016). There are studies that have shown that one will have a positive health outcome when these lifestyles are practised (Blanchard et al, 2008; Berman et al, 2018). For example, Foster-Schubert et al found in their study that exercises and healthy diet are effective in reducing weight in obese postmenopausal women (Foster-Schubert et al, 2011). But are these lifestyles independent of social and structural factors? This essay will focus on smoking, diet choices and physical exercises as health-lifestyles.

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Social and structural factors are multifaceted, integrated and overlying systems that can influence lifestyle choices (Townsend et al, 2017). This means that an individual’s health-related lifestyle choice can be greatly influenced by variables beyond the control. For example, an individual’s choice of diet may be influenced by what the person can afford and not what is considered healthy (Drewnowski, 2012). Age, gender, culture, income level, social media, education and environment are some of the examples of social and structural factors that can greatly influence an individual’s health-related lifestyle (He et al, 2017; Denton and Walters, 1999). Therefore, this essay will discuss the extent to which age, gender, culture, income level, education and environment influence diet choice, smoking and physical exercises.

There are theories that argue that individuals are units capable of making right lifestyle choices (Black, 1980; Deci, 1992) with little or no influence from social and structural factors (Ryan et al, 2008). From these theories, we can agree that health-related lifestyle choices are made based on personal preferences and self-determination. For example, fast foods (e.g. chips/chicken meal is £4) are more expensive than fruits and vegetables combined (orange is £0.30, and salad is £2) but the prevalence of fast food consumption is higher even in low and middle-income countries (Zhao et al, 2017). This then suggests that eating an unhealthy diet is the exclusive choice of the individual and it has little or no influence from social and structural factors (Sleddens et al, 2015).

Exercising regularly is also believed to be one of the healthy lifestyles an individual can choose with little or no influence from social and structural factors (Oh and Taylor, 2013). There are so many simple exercises available such as brisk walking and stretching (Apostolopoulos et al, 2015) that an individual can easily perform. Stretching for example helps regulate blood glucose and improve overall quality of life (Park, 2015).  With the emergence of social media, such exercises have become easily accessible (Monica et al, 2017). It is therefore the responsibility of the individual to make conscious effort to access these simple exercises and perform them. From this argument, we can conclude that social and structural factors have little or no influence on an individual’s decision to exercise.

Smoking is another health-related lifestyle that is argued to have little or no influence from social and structural factors like education (Cattaruzza, 2013). In fact, tobacco smoking kills up to half of its users, but the prevalence of smoking is still high (1.1 billion people worldwide) (World Health Organization, 2018). Assuming lack of education on the risk associated with smoking is the reason why people smoke tobacco, then why is smoking prevalence (15.5%) high in the United States (Jamal et al, 2018)? This is a country where 94.3% (from 2, 138 people surveyed) are aware of the risk of smoking (Hammond et al, 2006). Based on this evidence, it is reasonable to conclude that most people smoke because they want to and not because they are ignorant of the risks associated with smoking. Therefore, the argument that smoking is rarely influenced by social and structural factors like education may be valid. Although, the above arguments provide evidence that support the theory that social and structural factors have little or no influence on health-related lifestyles, there are also studies that have shown consistently that social and structural factors do influence lifestyle choices (Braveman and Gottlieb, 2014; Dover and Lambert, 2016). This essay will show the many complex and overlapping ways that social and structural factors influence the lifestyles described above. 

There are other theories that also believe that social and structural factors greatly influence health-related lifestyles (Bartley, 2016; Marmot, 2001). An individual’s choice of diet is influenced to a large extent by a complex interaction of factors such as culture, income and the environment (Dover and Lambert, 2016). In fact, variables such as food colour, smell, temperature and setting for food consumption can influence an individual’s choice of food (Stroebele and Castro, 2004). According to Bier, 2015, dietary practice is a learned behaviour and food has a great symbolic meaning in many cultures. For example, in some parts of Nigeria pregnant women are forbidden from eating egg. It is believed that egg causes jaundice in pregnant women. (Umar, 2014). For these pregnant women, their culture is the major determinant of their dietary lifestyle. There may be other substitutes for egg in that community, but are they aware? If they are, will that be accessible and affordable enough to be a choice? There is also the case of most healthy foods and fruits being seasonal in most countries (M’kaibi et al, 2015). For example, fruits such as avocados and blueberries which have antidiabetic properties are seasonal (Beidokhti and Jäger, 2017). Even during their seasons, these healthy foods are scarcer due to environmental pollution (Kassie et al, 2013). Climate change has worsened the situation by causing a general decrease in food production especially in developing countries (Battisti and Naylor, 2009). Consequently, prices of most foods have gone up and are difficult to access (Williamson et al, 2017). Because of these reasons, people are forced to make diet choices based on what is available and cheaper than what is healthy. The resultant effect is more fast food consumption (Zhao et al., 2017) a decision greatly influenced by social and structural factors.

As discussed earlier, some schools of thought believe that the desire and effort to exercise have little or no influence from social and structural factors, but there exist opposing views (Stierlin et al, 2015). Exercise as a lifestyle is also influenced greatly by social and structural factors such as age, gender, income and educational level (Danaei et al, 2017). Ageing limits one’s ability to exercise regularly because of impaired mobility, high risks of falls and overall decrease strength associated with ageing (Montero-Fernandez and Serra-Rexach, 2013). This factor will make regular exercises a difficult lifestyle for the aged to practice, unless it is prescribed as a remedy for a condition. In the case that exercise is the only remedy for a condition, age then can be a cause of health inequality. Research has shown that males exercise more than females (Nomaguchi and Bianchi, 2004) because of gendered stereotypes associated with exercising (Chalabaev et al, 2013). For example, the stereotype that females who actively exercise develop masculine features and thereby disturb the natural order of society is enough to deter most women from exercising (Eagly and Koenig, 2006). Furthermore, combining a full-time job and caring for a family leaves little or no time for women to engage in activities such as physical exercises (Dento and Walters, 1999). In this regard, women’s health outcomes in relation to exercises as a lifestyle will be lower than their male counterparts because of deeply rooted social influences. Additionally, lack of knowledge about the type of exercises to perform is one of the major reasons why most people do not exercise (Florindo et al, 2015). For such people their abstinence from physical exercises is because of lack of knowledge or ignorance. There is the argument of social media providing simple exercises that can be performed easily. But what happens to people who can’t afford social media, due to the cost of accessing internet and electricity? 

Smoking is also a lifestyle that is influenced greatly by social and structural factors such as environment and income level (Mao et al, 2014) although personal decisions could play a role as previously discussed. While nicotine addiction underpins smoking behaviour, the immediate environment is very important in determining who starts smoking and continues smoking throughout life (Jarvis, 2004).   Therefore, a child who is surrounded by habitual smokers while growing up will see smoking as a normal practice. Also, with the ever-growing work demands and stressors associated with globalisation, smoking is the outlet people use to relieve stress (Peckham et al, 2016). In this regard smoking is informed by their circumstance, which is stress from high work demands. In fact, even in seeking healthcare when there is a need to, social and structural factors put an individual in an uncomfortable position of choosing the cost of death over the cost of health (Ahmed et al, 2018). 

In conclusion, social and structural factors have a great impact on health-related lifestyles, both in linear and in very complex overlapping ways (Cdc.gov, 2018). Understanding the degree to which these social and structural factors influence health related lifestyles will help in developing effective and evidence-based health promotion tools that will address our diverse circumstances (Haire-Joshu and Tabak, 2016).

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