Chapter 31 Perceptions of risk and risk-taking behaviours

The identification of risk factors for disease is important for prevention. We know that social as well as biological factors are implicated in the patterning of ill health. However, there is also increasing emphasis on the importance of lifestyle and the role of health-related behaviours in both preventing and causing disease and ill health. Those behaviours that are deleterious to health can be termed risk-taking behaviours, because of the known risk they pose for an individual’s health. In recent years there has been a growing emphasis on individuals’ responsibility for their own health and the promotion of behaviour change to reduce an individual’s risk of disease and ill health (pp. 74–75).

This has brought with it an emphasis on self-control, on moderation in behaviour and on the provision of information to inform people of the risks to health associated with certain lifestyles and behaviours. However, it is important to recognize that individuals’ potential for control over their lifestyles, behaviours and health is limited by the social circumstances in which they live and which shape their lives (pp. 44–45). Understanding people’s own perceptions of risk and the contexts within which their risk-taking behaviours occur is important for doctors and others who may be assessing a patient’s risk of disease and encouraging a healthier lifestyle.

Perceptions of risk

Ignorance is often considered to be a major barrier to following lifestyle advice, although there is much evidence to suggest that the lay public are well aware of the publicized risks to health, such as the relationship between smoking and lung cancer or the range of risk factors associated with heart disease. In fact, research suggests that knowledge itself is not a powerful predictor of behaviour.

People may view a range of risks very differently. For example, salmonella infection from egg consumption was viewed as very risky when this was highlighted in the media, although the chances of infection were small. However, the longer-term risks of cholesterol and heart disease were not viewed in the same way. These different perceptions of risk may influence behaviour in different ways, with reactive lifestyle changes around egg consumption occurring quickly, but modification of diet to prevent heart disease being much harder to achieve.

People have a tendency to believe that their chances of experiencing a negative event, including illness, are less than average, but that their chances are higher than average for a positive event. This is called ‘unrealistic optimism’ or ‘optimistic bias’ (Weinstein, 1982). Factors regarded by individuals as decreasing their risk include both personal actions (for example, engaging in preventive health behaviours or seeking appropriate help) and psychological attributes such as personality, values held, likes and dislikes (for example, being the type of person who does not let things get you down, or being ‘health-conscious’). These are both associated with perceived controllability of the event. Environmental or hereditary factors are not perceived in the same way. The predominant characteristics affecting optimistic bias are: the belief that if the problem has not yet appeared, there will be an exemption from future risk; that the problem is perceived as preventable through individual action; that the hazard is perceived as infrequent; and that there is a lack of experience with the hazard (Weinstein, 1987). Some research has suggested that people nonetheless overestimate their absolute risk of a disease, such as breast cancer, and also overestimate the chances of surviving 5 years after diagnosis, of the cancer being curable and the chances of cancer being detected by mammogram (Clarke et al., 2000). However, in relation to perceived risk of disease, although people overestimate their own risk, they do this to a lesser extent than they do for others. In other words, they still retain an optimistic bias about themselves relative to similar others.

Optimistic bias may result in weakened intentions to prevent future ill health. However, in some cases, optimistic bias (in relation to control) may strengthen intentions to take preventive action because optimistic bias enhances self-efficacy (see pp. 142–143

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