ABSTRACT
A broad conclusion reached at the end of Chapter 9 was that ‘circumstances’—not only socio-economic circumstances and the external environment, but also the individual’s psycho-social environment—carry rather more weight, as determinants of health, than healthy or unhealthy behaviours. There is no doubt that the four behaviours examined, and in particular smoking, are relevant to health. They have most effect, however, when the social environment is good: rather less, if it is already unhealthy. Unhealthy behaviour does not reinforce disadvantage to the same extent as healthy behaviour increases advantage. This seems to suggest that the prior effect on health is the general lifestyle associated with economic or occupational position. Only in the more favourable circumstances is there ‘room’ for considerable damage or improvement by the adoption of voluntary health-related habits.
