Beyond behaviour: how health inequality theory can enhance our understanding of the ‘alcohol-harm paradox’

Boyd, J., Bambra, C., Purshouse, R. C. and Holmes, J. (2021) Beyond behaviour: how health inequality theory can enhance our understanding of the ‘alcohol-harm paradox’. International Journal of Environmental Research and Public Health, 18(11), 6025. (doi: 10.3390/ijerph18116025) (PMID:34205125) (PMCID:PMC8199939)

Abstract

There are large socioeconomic inequalities in alcohol-related harm. The alcohol harm paradox (AHP) is the consistent finding that lower socioeconomic groups consume the same or less as higher socioeconomic groups yet experience greater rates of harm. To date, alcohol researchers have predominantly taken an individualised behavioural approach to understand the AHP. This paper calls for a new approach which draws on theories of health inequality, specifically the social determinants of health, fundamental cause theory, political economy of health and eco-social models. These theories consist of several interwoven causal mechanisms, including genetic inheritance, the role of social networks, the unequal availability of wealth and other resources, the psychosocial experience of lower socioeconomic position, and the accumulation of these experiences over time. To date, research exploring the causes of the AHP has often lacked clear theoretical underpinning. Drawing on these theoretical approaches in alcohol research would not only address this gap but would also result in a structured effort to identify the causes of the AHP. Given the present lack of clear evidence in favour of any specific theory, it is difficult to conclude whether one theory should take primacy in future research efforts. However, drawing on any of these theories would shift how we think about the causes of the paradox, from health behaviour in isolation to the wider context of complex interacting mechanisms between individuals and their environment. Meanwhile, computer simulations have the potential to test the competing theoretical perspectives, both in the abstract and empirically via synthesis of the disparate existing evidence base. Overall, making greater use of existing theoretical frameworks in alcohol epidemiology would offer novel insights into the AHP and generate knowledge of how to intervene to mitigate inequalities in alcohol-related harm.

• Item Type: Articles
• Additional Information: This research was funded by The Wellcome Trust (108903/B/15/Z), the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (Award Number: R01AA024443) and the UKPRP SPIHER Consortium: Systems science in Public Health and Health Economics Research (MR/S037578/1).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Boyd, Dr Jennifer

Creator Roles

Boyd, J.: Conceptualization, Investigation, Writing – original draft

• Authors: Boyd, J., Bambra, C., Purshouse, R. C., and Holmes, J.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: International Journal of Environmental Research and Public Health
• Publisher: MDPI
• ISSN: 1661-7827
• ISSN (Online): 1660-4601
• Published Online: 03 June 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in International Journal of Environmental Research and Public Health 18(11): 6025
• Publisher Policy: Reproduced under a Creative Commons License