Behavioural and structural factors in the explanation of socio-economic inequalities in health: an empirical analysis

The aim of this study was to investigate the importance of ‘cultural/behavioural’ and ‘materialist/structuralist’ explanations for socio-economic inequalities in health, and to examine the interrelationship between them. We used data from a survey among a sample of the population in the southeastern part of the Netherlands. When analysed separately, both behavioural and structural factors contributed substantially to observed inequalities in health. In a simultaneous analysis, both groups of factors had a substantial part of their contribution in common. We denned the overlap as an indirect contribution of structural conditions, through behaviour. If that overlap is ignored, this could lead to an overestimation of the behavioural explanation. In our analysis, the total (direct plus indirect) contribution of structural factors is larger than that of behavioural factors. However, because of, in particular, the cross-sectional character of the data, these analyses must not be considered a final answer as to the question of the relative contribution of behavioural and structural factors. Instead, they are an illustration of the way their importance could be assessed, taking the effect of structural conditions on lifestyle into consideration.