The Uncontrollable Mortality Risk Hypothesis of Health Behaviour: a Position Paper

Abstract

Greater levels of perceived uncontrollable mortality risk have been associated with lower reported health effort in previous research, but the topic remains understudied. The ‘Uncontrollable Mortality Risk Hypothesis’ states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviours. We distinguish the theoretical assumptions of the Uncontrollable Mortality Risk Hypothesis from related theory and stress the importance of incorporating evolutionary perspectives into public health. We then describe Pepper and Nettle’s (2014) measure of perceived uncontrollable mortality risk, presenting a replication of their work. Further, we provide new analysis to suggest it offers a substantially more effective predictor of health effort than the Multidimensional Health Locus of Control Scale - a well-used measure of a similar construct, which is frequently found to be associated with health behaviour. We suggest that public health interventions consider the relationship between overall levels of mortality risk and multiple health behaviours, rather than narrowly addressing individual risks and behaviours. We emphasise the importance of addressing structural disparities in risk exposure, as well as highlighting the more-immediate benefits of investing in preventative health behaviours to those less likely to enjoy the long-term benefits. Measuring perceived uncontrollable mortality risk may help to identify specific risks that are commonly perceived as uncontrollable, in order to provide targeted interventions for improving health behaviours.

Individual characteristics associated with perceptions of control over mortality risk and determinants of health effort

“…The UMRH provides an ultimate explanation for socioeconomic gradients in health by modeling the expected health response to experiencing higher levels of uncontrollable risk. The UMRH suggests that people who are more likely to die as a result of factors that are beyond their control should be less motivated to engage in positive health behaviors (Brown & Pepper, 2022, 2023; Pepper & Nettle, 2014a). This is based on a behavioral ecological model for explaining social gradients in preventative health behaviors, which states that the optimal individual investment in health behavior should be less for people of lower socioeconomic status (Nettle, 2010).…”