Expensive health promotion campaigns have failed repeatedly because of a failure to tackle the root causes of inequality, according to researchers.
Experts say international evidence demonstrates a clear link between poor health and social factors such as unemployment, poverty, lack of opportunity, bad housing and community breakdown.
But even the best-intentioned public health campaigns suffer from 'lifestyle drift' and always end up blaming poor people for their problems.
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Professor Chik Collins, of the University of the West of Scotland, co-author of the new research, said: "Huge amounts of money have been expended on something which doesn't work and isn't going to work. In fact a lot of health education work can exacerbate health inequalities, because the people who respond to the messages are those who are already healthy."
The authors claim that some policymakers do recognise the social and political realities behind Scotland's wide health inequalities. This can result in efforts to improve people's material circumstances, but too often such policies break down and revert to simply demanding poor people take more responsibility for their diet, or for giving up smoking or drinking - then blaming them when they can't change their behaviours.
The report implies this approach looks cheaper and quicker, but is doomed to failure. It says "Behavioural interventions aimed at changing the lives of poor individuals clearly have a powerful draw on the attention of policy makers. The reasons for this preference are many and varied and include the desire for quick policy wins, and the seductive appeal of short and simplistic causal pathways to health."
Mhairi McKenzie, Professor of public policy at Glasgow University, led on the study. She said there was extensive evidence that people's material circumstances play a major part in creating health inequalities, but a big gap between that and the actual polices implemented by governments.
"In the end, we seem to say 'lets try and get poor people to use services better and find new ways of getting them to stop drinking, rather than thinking what can we do about the more fundamental causes."
Researchers spoke to people in deprived circumstances in Kilmarnock and Cumnock and found many had a sophisticated understanding of the problems they face.
When people in the Ayrshire towns were asked, they talked about decades of being stigmatised and viewed as a problem. But many had a different take on why their health was poor, identifying social policies which had damaged industries and communities as critical.
Some believed current strategies were designed to set poor and struggling communities apart from the rest of society.
"They gave us vivid stories about how politics and polices create poor health and what it was like to be on the sharp end of economically damaging processes - whether that is the decline of industry or welfare cuts," Prof McKenzie said.
The paper:‘I don’t smoke; I don’t drink. The only thing wrong with me is my health’, calls for people in poor communities to be given the chance to educate those working to tackle health inequality, and for more discussion of ways to improve people's circumstances.
It is part of the University of the West of Scotland Oxfam partnership which is seeing the university work with the development charity to bring academics and students together with poverty campaigners to drive research.
Mr Collins said the temptation was too ignore equalities and blame the victim: "People would say: 'We've taken every opportunity to work with these people and just can't get them to change their behaviour'. It is blaming the victim," he explained.
"Yet another campaign to get people to give up booze and fags is more evidence of this tendency to blame people. It is a failed mindset," he said.