Why public health campaigns may have to rethink their messaging
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A version of this commentary appeared in the Winnipeg Free Press, Vancouver Province and the Edmonton Sun
Exercise is good for you. Eat more fruits and vegetables. Stop smoking. Drink less alcohol. Such messages abound in public health campaigns and there is a firm belief that they will ultimately change behavior. This is based on the assumption that individuals are motivated to change behaviors to reduce their individual health risks.
While healthy individuals may understandably ignore such messages, one would certainly assume that people who already have conditions amenable to behavior change (like diabetes, heart or respiratory disease) would perhaps be more motivated to mitigate their risk by living healthier.
This, according to a study just released by Statistics Canada, is not the case. It seems that simply knowing about health risks does not change behavior.
In fact, the 12 years of longitudinal data from the Canadian National Population Health Survey among Canadians aged 50 or older shows that three in four smokers with respiratory disease do not quit smoking, most people with diabetes or heart disease will not become more physically active and virtually no one diagnosed with cancer, heart disease, diabetes or stroke will increase their intake of fruit and vegetables.
This does not bode well for public health promotion campaigns that simply appeal to Canadians to give up unhealthy behaviors to reduce their future risk of disease.
If even those who are most likely to immediately benefit from changing their lifestyles fail to live healthier, what is to be expected of those for whom such recommendations merely promise better health somewhere in the distant future? Or, if even already having the condition does not change behavior, why would we expect mere fear of developing the condition to be enough of a motivator?
The solution cannot be more drastic or broader messaging. One would assume that people with chronic diseases are already being provided a fair dose of health education and messaging from their health providers — certainly more than could ever be offered to the general public through broader health information campaigns.
As many experts in health promotion are well aware, knowledge and warnings are the least effective measures to change health behaviors. This is why many call for health policies that ban or restrict access to tobacco, alcohol and unhealthy foods as well as punitive measures, including taxation and fines or higher health premiums for those who persist.
However, such measures fail to acknowledge the key drivers — why people adopt unhealthy behaviors in the first place — and why these behaviors are so difficult to change.
Most people make decisions about what they eat based on taste, cost and convenience rather than on health benefits or health risks. Most people fail to exercise regularly because they either lack the time or simply do not enjoy being physically active. In certain social circles, smoking and excessive alcohol consumption are an accepted part of cultural identity — a value that supersedes potential health risks. And, let us not forget that food, nicotine and alcohol can all be used as coping strategies for a life that has its everyday stressors and challenges.
It is therefore not surprising that forward-thinking public health strategies (such as New Brunswick’s “Live Well – Be Well” strategy) focus considerable effort on promoting mental fitness and resilience rather than on simplistic messages around “healthy-active living.”
Research shows that a higher degree of mental fitness not only increases a person’s ability to efficiently respond to life’s challenges but also to effectively restore a state of balance, self-determination and positive change.
Resilience is strengthened by positive relationships, experiences and inner strengths such as values, skills and commitments. It is particularly fostered by addressing our needs for relatedness (a heightened sense of belonging in the workplace, schools, communities and homes), competency (building on existing individual strengths and capacity) and autonomy (self-determination of activities that will enhance health and well-being).
Obviously, these determinants of health behaviors are far more difficult to legislate than simply banning or taxing unhealthy foods or imposing punitive levies on tobacco or alcohol. Indeed, fostering a societal discourse on the role of culture and values (including how we deal with poverty and social inequities) as a contributor to our health and well-being may well be beyond the scope of current public health initiatives. In the end, however, it will take more than warnings and by-laws to make us healthier.
Arya M. Sharma, MD, is an expert advisor with EvidenceNetwork.ca, Professor and Chair in Obesity at the University of Alberta and Scientific Director of the Canadian Obesity Network.
This work is licensed under a Creative Commons Attribution 4.0 International License.