If you believed you were likely to be a victim of a stabbing before the age of 30, would eating your 5 a day seem very important?
People who believe they are likely to die due to factors beyond their control take less care of their health because they are less likely to live to see the long-term benefits of a healthy lifestyle.1-3 However, little is known about what causes of death are thought to be beyond individual control, or why. By surveying a UK representative sample, we aim to investigate what causes of death are widely believed to be uncontrollable and what information people use to assess personal risk. This information can be used to establish which risks may be key drivers of unhealthy behaviour. We also aim to investigate how social class affects beliefs about control over risk, because theory suggests that class differences in these beliefs may worsen existing health inequalities. Our findings will be used to compile a report with recommendations for public health interventions aimed at reducing avoidable deaths.
Approximately 23% of deaths in the UK in 2019 were considered avoidable, many of them being due to diseases associated with unhealthy behaviours (e.g., cardiovascular disease, respiratory disease, and illnesses related to drug and alcohol use).4 Based on behavioural ecological theory,5 the Uncontrollable Mortality Risk Hypothesis predicts that people who are exposed to risks beyond their personal control should invest less effort in looking after their future health.3 People of lower social class typically experience greater exposure to risks that are beyond their control (such as exposure to pollution, hazards at work, poor water quality, threat of violence, and COVID-19 infection and fatality rates).6-14 We have found that this contributes to social class differences in health behaviour. In one of our studies, social class differences in reported health effort were entirely explained (statistically speaking) by perceived uncontrollable mortality risk.2 This suggests that perceived control may be an important driver of social class differences in health behaviour. Indeed, our recent research during the COVID-19 pandemic found that perceived uncontrollable mortality risk was associated with lower adherence to Government advice on diet and physical activity, as well as higher levels of smoking.1 Therefore, understanding how we perceive uncontrollable mortality risk may be fundamental to tackling socioeconomic gradients in health. However, we still know very little about people’s personal sense of control over the risks they face. Since perceived control of mortality risk is a key motivator of health behaviour, it is important to explore the concept further.
This project will address the following research questions:
RQ1. What types of mortality risk are perceived to be uncontrollable? For example, is risk of death from cardiovascular disease perceived as being more controllable than cancer-based mortality risk?
RQ2. What are the sources of information that inform perceptions of uncontrollable mortality risk? For example, are beliefs about controlling your risk of death influenced more by your own family medical history, by rates of violent crime in your area or by discussions with those in your social circle?
RQ3. Are there social class differences in perceptions of control over these risks, and are there any differences in the sources of information used to form these perceptions?
A nationally representative sample of 1,500 people will be surveyed via Prolific. This sample size is based on recent guidance and practices set by YouGov and the Office for National Statistics for surveying the opinions and perceptions of the UK public.15, 16 Participants will provide their age, gender, ethnicity, income and occupational class. Participants will be asked to rate their level of personal control over their risk of dying from leading causes of avoidable death in UK (e.g., heart disease, respiratory illness, and common cancers).4 They will also be asked to rate their perceived controllability of various risks from the National Risk Register (e.g., flooding, fires, transport accidents and terrorist attacks).17 Participants will provide a measure of overall perceived uncontrollable mortality risk by stating a score for their believed likelihood of living to 81 (the average UK life expectancy), provided they make the maximum effort to look after their health.2, 18 Participants will then list any further risks which they believe to be beyond their personal control. This will help to identify perceived sources of risk that could be explored in future studies. Finally, participants will indicate the sources of information from which they learn about each risk. These questions will be based on sources of information most relevant to forming perceptions of health and risk of death, which include healthcare professionals, internet, TV, radio, print media, family, friends and colleagues.19, 20
Our analysis will determine which causes of death are typically believed to be uncontrollable and identify the most commonly used sources of information that inform beliefs about risk. Our investigation of social class will look to identify differences in perceptions of control over various causes of death, as well as differences in the information seeking behaviours relevant to these perceptions.
We are asking for £5,596.53 in credit based on Prolific’s costing tool for providing a nationally representative sample of 1,500 people. The survey will take approximately 15 mins to complete and participants will be reimbursed for their time in line with the UK living wage (£8.91 per hour).21
Data and dissemination
Our full study protocol will be available on the Open Science Framework (OSF; OSF | Gillian Pepper). Once the study has been conducted, a preprint will be made available on the OSF alongside our preregistration, data, and analysis scripts. The findings will be submitted for publication and supported by an accessible explainer video (similar to that created for our recent COVID-19 research1; youtube.com/watch?v=9wgtlDdqqbs). A report containing a lay summary of key findings along with public health policy recommendations will also be made available on OSF.
Expected contribution and impact
Knowing what mortality risks are broadly perceived to be beyond personal control may present clear targets for public health interventions. For example, if a particular risk is typically believed to be uncontrollable, and is genuinely so (e.g., disease risk due to air pollution), then taking publicly visible steps to tackle the problem may encourage improved health behaviour, as well as tackling the problem itself. Further, if some risks which are strongly affected by lifestyle (e.g., cancer risk) are perceived as being uncontrollable, then health campaigns that emphasize the efficacy of a healthy lifestyle for reducing that risk are likely to lead to improved health behaviours. Insights from this study will therefore be used to write a report, summarising our findings, and making public health recommendations aimed at providing interventions to improve health behaviours and reduce socioeconomic inequalities in health.
Thank you for your interest and we would very much appreciate your vote!
Dr Gillian Pepper and Richard Brown
Psychology Department, Northumbria University
- Brown R, Coventry L and Pepper G. COVID-19: the relationship between perceptions of risk and behaviours during lockdown. Journal of Public Health 2021: 1-11.
- Pepper GV and Nettle D. Perceived extrinsic mortality risk and reported effort in looking after health. Human Nature 2014; 25: 378-392.
- Pepper GV and Nettle D. Out of control mortality matters: the effect of perceived uncontrollable mortality risk on a health-related decision. PeerJ 2014; 2: e459.
- Office for National Statistics. Avoidable mortality in the UK: 2019. Office for National Statistics London, 2021.
- Nettle D. Why are there social gradients in preventative health behavior? A perspective from behavioral ecology. PLoS One 2010; 5: e13371.
- Evans GW and Kantrowitz E. Socioeconomic status and health: the potential role of environmental risk exposure. Annual review of public health 2002; 23: 303-331.
- Bolte G, Tamburlini G and Kohlhuber M. Environmental inequalities among children in Europe—evaluation of scientific evidence and policy implications. European journal of public health 2010; 20: 14-20.
- Fairburn J, Schüle SA, Dreger S, et al. Social inequalities in exposure to ambient air pollution: a systematic review in the WHO European Region. International journal of environmental research and public health 2019; 16: 3127.
- Shaw M, Tunstall H and Dorling D. Increasing inequalities in risk of murder in Britain: trends in the demographic and spatial distribution of murder, 1981–2000. Health & place 2005; 11: 45-54.
- Redelings M, Lieb L and Sorvillo F. Years off your life? The effects of homicide on life expectancy by neighborhood and race/ethnicity in Los Angeles County. Journal of Urban Health 2010; 87: 670-676.
- Evans GW and Kim P. Multiple risk exposure as a potential explanatory mechanism for the socioeconomic status–health gradient. Annals of the New York Academy of Sciences 2010; 1186: 174-189.
- Cifuentes MP, Rodriguez-Villamizar LA, Rojas-Botero ML, et al. Socioeconomic inequalities associated with mortality for COVID-19 in Colombia: a cohort nationwide study. J Epidemiol Community Health 2021.
- Hawkins RB, Charles E and Mehaffey J. Socio-economic status and COVID-19–related cases and fatalities. Public health 2020; 189: 129-134.
- Sá F. Socioeconomic determinants of Covid-19 infections and mortality: evidence from England and Wales. 2020.
- Office for National Statistics. Data collection changes due to the pandemic and their impact on estimating personal well-being . 2021.
- YouGov. Research Q&A’s, YouGov | Research Q&A's (2021).
- Cabinet Office. National Risk Register 2020. UK Government, 2020.
- Brown R, Coventry L and Pepper G. COVID-19: the relationship between perceptions of risk and behaviours during lockdown. 2020. DOI: 10.31219/osf.io/dwjvy.
- Cutilli CC. Seeking health information: what sources do your patients use? Orthopaedic nursing 2010; 29: 214-219.
- Brown R, Coventry L and Pepper G. Information seeking, personal experiences, and their association with COVID-19 risk perceptions: demographic and occupational inequalities. Journal of Risk Research 2021; 24: 506-520. DOI: 10.1080/13669877.2021.1908403.
- UK Government. National Minimum Wage and National Living Wage rates. 2021.