The role of fatalism in health behaviour has stirred significant controversy in literature across several disciplines. Some researchers have demonstrated a negative correlation between fatalistic beliefs and healthy behaviours such as cancer screening, arguing that fatalism is a barrier to health-seeking behaviours. Other studies have painted a more complicated picture of fatalistic beliefs and health behaviours that ultimately questions fatalism’s causality as a distinct factor. Unpacking this debate raises thought-provoking questions about how epistemological and methodological frameworks present particular pictures about the connections between belief, race, class and behaviour. The discussion surrounding fatalism illuminates larger tensions between structural and cultural determinants of health behaviour. This article argues for a more rigorous delineation of culture and structure and suggests that future theory-informed and ethnographic research may more precisely parse the role of fatalism in health attitudes, beliefs and behaviours.