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    • Our research has identified that behavioural indicators are

    2018-11-07

    Our research has identified that behavioural indicators are the least important of the categories determining the inequality gap in mental health and wellbeing. This is true for both mental health measures. This is important, as much public health activity focused on reducing health inequalities tends to lean towards behavioural interventions and individual behaviour change. This shift towards a focus on the individual has been labelled as ‘lifestyle drift’ (Hunter, Popay, Tannahill, Whitehead & Elson, 2009: 3). Increasing physical activity is a much-used piece of advice given to people to improve their mental wellbeing (e.g. NHS, 2014a), alongside ‘eating healthy’ and drinking less alcohol as a means to combat depression (NHS, 2014b). We have found that although behavioural factors such as exercise play a role in mental health and wellbeing, they THZ2 seem to have a far smaller direct impact than either structurally based material factors or psychosocial components. The participants in our study who drank alcohol actually had better mental health scores than the non-drinkers, although this may have been related to people abstaining from alcohol use as a result of physical health problems. It may have also been related to the context in which participants consumed alcohol: meeting up with friends in a pub may, for some, serve as a protective factor because of the added social benefits incurred from this. It does, however, need to be recognised that the study used general measures of mental health and wellbeing. It may be the case that the determinants of more clinical indicators of poor mental health may differ from the determinants of general mental health and wellbeing identified in this study. There is, for instance, a strong link between alcohol consumption, depression, and suicide (WHO & Calouste Foundation, 2014), although socioeconomic factors appear to have comparable effects on both mental wellbeing and mental health problems (Huppert, 2009). Previous international research on welfare changes has shown that where welfare services are cut, this increases inequalities in mortality and morbidity: whilst overall population health is generally unaffected, cuts in welfare have a detrimental impact on the health of the poorest (Krieger et al., 2008; Blakely, Tobias & Atkinson, 2008; Shaw, Blakely, Atkinson & AND Crampton, 2005). Across England there has been an increase in indicators of poor mental health since 2010, and evidence nationally of widening inequalities in mental health (Barr, Kinderman & Whitehead, 2015). Whilst population mental health usually declines during an economic recession and then recovers, this has not been the case in the current period. Mental health continues to be affected, including an increase in rates of suicides, with 2013 witnessing the highest male suicide rate since 2001 (ONS, 2015). The largest increase in poor mental health (including suicides, self-reported mental health problems and anti-depressant prescription rates) have been in the most deprived areas, leading to increasing inequalities in mental health (Barr, Taylor-Robinson et al., 2015). Whilst the baseline findings of this study cannot demonstrate temporal changes during the period of austerity, our findings lend support to the argument that socioeconomic factors play a significant role in driving inequalities in mental health and mental wellbeing at a localised level. There are already substantial inequalities between people from the most and least deprived areas of the local authority, and as such, any increase in deprivation amongst the poorest (for example as a result of welfare changes) may further impact on these inequalities. Health profiles on Stockton-on-Tees have identified that since 2010, the life expectancy gap between the most and least deprived areas has worsened in the local authority (Public Health England, 2015). This would suggest that health inequalities have indeed grown since the onset of austerity. Whether inequalities in mental health and mental wellbeing change during austerity will be examined further in the follow-up waves of the Stockton on Tees cohort study.