EDMONTON,
ON, Dec. 11, 2012/ Troy Media/ – Exercise is good for you. Eat more
fruits and vegetables. Stop smoking. Drink less alcohol.
Such messages abound in public health campaigns, and are based on the
assumption that at-risk individuals will ultimately change their
behaviour and mitigate their risk by living healthier.
But according to a study just released by Statistics Canada, that is not the case.
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 behaviours 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 behaviour, 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 behaviours in the first place – and why these
behaviours 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 behaviours 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.
credit: http://www.troymedia.com/2012/12/11/does-knowing-your-health-risks-change-behaviour/
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