Investigating the relationship between perceptions of uncontrollable mortality risk and health behaviours

Abstract

The Uncontrollable Mortality Risk Hypothesis (UMRH) employs a behavioural ecological model of human health behaviours to explain social gradients in health. It states that people who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviours. This thesis outlines the theoretical assumptions of the UMRH and encourages the incorporation of evolutionary perspectives into public health by measuring Perceived Uncontrollable Mortality Risk (PUMR). Qualitative and quantitative methods were used to investigate the relationship between PUMR and health effort. Semi-structured interviews examined perceptions of control over possible causes of death. This informed a quantitative survey of a nationally representative online sample of 1,500 UK participants. Survey data were analysed to examine variation in perceptions of risk between different causes of death, and to investigate individual differences in predictors of PUMR. Perceived control over specific causes of death did not predict PUMR (with the exception of cardiovascular disease). Differences in the demographic and socioeconomic predictors of perceptions of risk suggest that PUMR may capture a ‘general sense’ of mortality risk, influenced by exposure to hazards and the availability of resources. This thesis also replicated Pepper and Nettle (2014), supporting their findings, with PUMR mediating 24% of the total effect of subjective socioeconomic position on health effort. Finally, combining data from this thesis and earlier research, a mini meta-analysis indicated a medium-sized negative relationship between PUMR and health effort, highlighting the value of PUMR as a predictor of health behaviours. These findings emphasise the importance of addressing structural inequalities in risk exposure. Health interventions should examine the relationship between overall levels of mortality risk and health behaviours across multiple domains. Measuring PUMR may also capture unanticipated health benefits of structural risk interventions and help to assess the appropriateness of different health interventions.

Date of Award	24 Oct 2024
Original language	English
Awarding Institution	Northumbria University
Supervisor	Gillian Pepper (Supervisor) & Liz Sillence (Supervisor)