Behavioural determinants of health and disease

This chapter reviews ways in which behaviour relates to the spectrum of health and disease determinants, from environmental to genetic, in shaping health outcomes. It builds on the previous chapters in recognizing the powerful influence of socioeconomic and cultural factors, especially poverty and discrimination, in influencing both behaviour and health. Many commentaries in the past four decades have attempted to correct the overemphasis on individual behavioural determinants of health by discounting and sometimes disparaging any focus on individual behaviour or personal responsibility in disease prevention and health promotion. This chapter seeks a middle ground, building on the growing understanding of the ecological and cultural context of the behaviour–health relationship. It seeks to integrate that knowledge in an approach to public health that acknowledges the reciprocal determinism of behavioural, environmental, and biological determinants rather than minimizing the importance of behaviour in these complex interactions.