Beyond Behaviour: How Health Inequality Theory Can Enhance Our Understanding of the ‘Alcohol-Harm Paradox’

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.

Do Changes to the Alcohol Retail Environment Reduce Interpersonal Violence?

“…Thus, alcohol retail environments impact violence not just through how much alcohol each person in a population consumes, but also potentially through the cumulative interplay of embodiment, exposure, susceptibility, and resistance. The alcohol harms paradox [22,61], the observation that those with lower incomes consume less alcohol but experience more alcohol-related problems, has also insufficiently been incorporated into the literature on alcohol environments and violence. This is similar to observed alcohol inequities related to interpersonal violence among those with one or more minoritized identities.…”

“…Over the past decade, researchers have been calling for the use of novel methods to better understand mechanisms underpinning the relationships between and inequities in population-level patterns of alcohol consumption and various forms of violence and the structural causes of these patterns [7,20,21]. This body of research has also traditionally needed to better utilize theoretical frameworks that can tie together population-and individual-level alcohol consumption, alcohol inequities, and the ways through which alcohol retail interventions can reduce or eliminate alcohol-related violence [22]. Moving beyond descriptive epidemiology, we are left with the question of how to best generate evidence that can lead to the successful implementation of alcohol retail control that will benefit those at highest risk for interpersonal violence.…”

Economic and social deprivation predicts impulsive choice in children

“…This leaves around 50% of the variance attributable to environmental factors to be identified. Although it is already recognised that there are health inequalities across the UK relating to impulsive behaviour 26 – 28 , there is emerging evidence that the associated discount rates are not uniformly distributed across society and that these may be related to differences in economic circumstances. For example, Anokhin et al 17 noted that discount rates in 14 year olds were associated with socio-economic status based on parental occupation.…”

Alcohol Consumption Patterns: A Systematic Review of Demographic and Sociocultural Influencing Factors

“…Alcohol consumption adversely affects consumers' driving performance, as it also has a degradation effect on vision [16]. Additionally, socioeconomic inequalities could result in inequal alcohol-related harm, despite similar consumed quantities [17,18]. Although a number of interventionist approaches have been implemented by governments to lower the rate of alcohol consumption, life-threatening situations due to alcohol abuse still prevail [19].…”