Should Public Health Campaigns Change Their Messages?

The following is an Op-Ed that appeared in several Canadian news outlets:

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 behaviours.

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 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 wellbeing).

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 wellbeing may well be beyond the scope of current public-health initiatives.

Edmonton, Alberta