We have demonstrated time and again that society has a massive impact on your health For example, an analysis of East London found that diabetes rates mapped almost perfectly to rates of social deprivationpic.twitter.com/9LbDP7B6aX
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We also know that this sort of health advocacy is most effective for people who are already well-off. A major part of my PhD is addressing the inequities caused by providing health services in an inequitable way
For example, one study found that people were less likely to use a free weight control app if they were poor, non-white, or had multiple comorbidities
This is true across the board - if you run a health intervention, the people who are at the top already will usually benefit the most It's formally describe in public health in the equity effectiveness looppic.twitter.com/VjJ69sGQVD
The basic idea is that a health intervention - say, a mobile self-management app - has to go through stages to be effective. Someone has to have access to it, download it, use it, continue to use it, and benefit from it
At each stage in this cycle, social factors get in the way If you don't have a phone, you can't access an app If you don't understand the language used for the app, you can't download or use it And on, and on
Ultimately, personal responsibility is a great thing to tell an individual, but not useful at all at the population level
If you truly want to improve outcomes, you have to address larger social outcomes rather than talking about what actions individuals do and do not take
I've written about all of this before - it's more expensive and politically difficult to change the environment, but if we don't we'll probably never address many of our disease problemshttps://medium.com/@gidmk/personal-responsibility-is-a-meaningless-term-8c1f7732993b …
Also important to note, this is not just limited to health. As this thread aptly demonstrates, welfare and social programs are interlinked with healthcare effortshttps://twitter.com/drcbond/status/1059568949359038465 …
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