Are We Over-Psychologising Public Health Problems?
- Daniel Gaffiero
- 1 day ago
- 5 min read
We like to think health psychology helps people make better choices. But what if, sometimes, it just makes it easier to blame them?
I’ve always been fascinated by the gap between what people know they should do and what they actually do. Why do some people ignore health advice, while others make lasting changes to improve their wellbeing? As a lecturer in health psychology, I spend most of the academic year teaching and supervising research on health promotion and behaviour change. We explore why people smoke, struggle to exercise regularly, attend screening appointments, or take medication as prescribed, and how psychological theory can help explain and predict these behaviours. In many ways, health psychology is built around an important question: how can we help people live healthier lives?
Over the past few decades, behaviour change has become one of the dominant approaches in public health, and for good reason. The behaviours people engage in can have major implications for disease prevention, long-term health, and quality of life. Psychological theories are now embedded everywhere: smoking cessation campaigns, vaccination strategies, and even workplace wellbeing initiatives. I regularly taught theories and models that focused on beliefs, motivations, habits and decision-making. But over time, I’ve become increasingly uncomfortable with how easily behavioural explanations can drift into behavioural blame. The logic seems straightforward: if unhealthy behaviours contribute to poor health outcomes, then changing behaviour must be part of the solution. But this raises an awkward question: what happens when the primary barriers to health are not the individual behaviours themselves, but the wider social, economic and structural conditions shaping them?
The Behaviour Change Mindset
Across public health campaigns, healthcare systems, and even social media, behaviour change approaches have increasingly become the default response to complex health problems. Smoking? Emphasise the health consequences and encourage cessation. Obesity? Promote healthier eating and increased physical activity. Vaccine hesitancy? Reassure people about vaccine safety and address misinformation. Over time, this way of thinking can subtly reshape how we understand health itself. Health becomes framed as a reflection of discipline, motivation, and personal responsibility.
Admittedly, I’ve recently caught myself slipping into this way of thinking too. During supervision of one of my PhD students examining parental influenza vaccine decision-making, I became heavily focused on beliefs, attitudes, mistrust, and hesitancy. But after speaking with a Director of Public Health, I realised I had overlooked something much more basic: for most parents, the key barriers had included difficulty navigating complicated consent procedures, understanding information forms, language barriers, or not knowing how to access catch-up services. Here, my error was placing disproportionate emphasis on the psychology and overlooking the broader influences of vaccination uptake. Psychological factors matter, but they exist within wider social and structural conditions that shape whether healthy behaviour is realistically possible.
This is not to say health psychologists ignore social determinants of health. Contemporary behaviour change models recognise environmental and structural influences on behaviour. Nevertheless, public health interventions often continue to emphasise individual responsibility for health behaviour, potentially obscuring the broader structural factors that shape people’s opportunities and choices. Therefore, behaviourally informed interventions designed to change knowledge, beliefs or attitudes, are unlikely to prove effective if individuals face barriers that hinder their ability to engage in healthy behaviours in the first place. For example, encouraging women to attend breast cancer screening through educational campaigns may have limited impact if appointment times, transport difficulties, caring responsibilities or inflexible working arrangements make attendance impractical.
The Hidden Shift from Understanding to Responsibility
Behavioural explanations do not just shape how we understand health - they also shape who we hold responsible for it. Discussions about health inequalities often begin by acknowledging wider social problems such as poverty, insecure employment, or unequal access to healthcare. But surprisingly quickly, the conversation can drift back toward individual choices, behaviours, and personal responsibility. Structural problems become reframed as behavioural ones.
Take vaccination, for example. Vaccine hesitancy has often been approached through a knowledge-deficit model – the assumption that low uptake primarily reflects a lack of knowledge or misunderstanding about vaccines. Consequently, interventions have frequently focused on providing information and correcting misconceptions in the hope that this will increase vaccine acceptance. Yet, vaccine attitudes are shaped by far more than information alone. Trust, social norms, previous experiences with healthcare, and wider social contexts can all shape whether someone chooses to vaccinate. This means institutional credibility may be just as important as factual knowledge itself. During the COVID-19 pandemic in the UK, campaigns such as “Can you look them in the eyes?” relied heavily on emotional appeals to encourage compliance with public health restrictions. While such approaches may influence behaviour in the short-term, communication strategies perceived as manipulative or fear-driven may carry longer-term consequences for institutional trust and public engagement with healthcare.
Psychologically framed explanations can feel progressive because they focus on empowerment and personal agency. But they can also allow governments and institutions to sidestep conversations about inequality, poverty, and access to care. It is often easier to ask individuals to change their behaviour than to tackle the structural conditions that limit their choices.
When Behavioural Interventions Miss the Point
Many behavioural interventions are designed around the assumption that people simply need more education, changed beliefs, or stronger motivation to alter their behaviour. However, Albarracín and colleagues’ (2025) review, “Determinants of behaviour and their efficacy as targets of behavioural change interventions”, found that interventions focused primarily on knowledge, general attitudes and beliefs were often far less effective than those addressing access and social support.
Smoking illustrates why purely individually focused approaches can fall short. Smokers are repeatedly exposed to graphic warning labels and messages about cancer risk. Most know smoking is harmful. Likewise, many people experiencing financial hardship know the importance of eating healthily, sleeping properly, and managing stress. The problem is not always education. People’s circumstances can make healthy behaviours far harder to maintain. Telling someone to exercise more while they work multiple insecure jobs and care for family members ignores the realities shaping their behaviour. Discouraging “unhealthy choices” means little when healthier foods are financially inaccessible or unavailable.
So, What Should Health Psychology Do Instead?
None of this means behaviour change should be abandoned. Behaviour matters, and psychological interventions can genuinely improve health outcomes. Before attempting to change behaviour, we may first need to ask whether people realistically have the opportunity, stability, resources, or access required to engage in that behaviour in the first place. In some cases, the most effective intervention may be improving service accessibility, reducing financial barriers, or addressing wider structural conditions.
Perhaps that is what I have come to appreciate most about health psychology. The longer I teach and research behaviour change, the less interested I become in asking why people fail to make healthy choices, and the more interested I become in understanding the circumstances that make those choices easier for some people than others. If there is a risk of over-psychologising public health problems, it is not because psychological explanations are wrong. It is because they can become so persuasive that we forget to look beyond the individual.
