Simply knowing about health risks does not change behavior

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 is a professor of medicine, University of Alberta, scientific director, Canadian Obesity Network. and an expert advisor, Evidence Network.  He blogs at Dr. Sharma’s Obesity Notes.

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  • buzzkillerjsmith

    You’re not breaking any new ground here. Aristotle thought that to know the good was to act in accordance with the good but most of us since then don’t.

  • Steven Reznick

    Educating children from an early age on healthy lifestyle is the only way. Getting parents and communities to buy into the concept of healthy living and being examples to their children will work. Part of the education needs to include teaching youngsters coping mechanisms and how to productively overcome obstacles and deal with stress. Smoking and alcohol and drugs need to be made less preferable than going to the gym and getting in a good workout on the heavy bag or taking a long walk or run or swim to work off your stress

  • Kate Curry

    In the end, however, it will take more than warnings and by-laws to make us healthier.
    Like what? Imprisonment and re-education camps?

  • Fred Ickenham

    And yet the ACA explicitly makes the health care worker “Accountable” for such patient behavior, with financial penalties. True believers or intent to fail?

  • Dorothygreen

    OK, all you say is true and no one will disagree with you. However, the US did do one great thing that decreased tobacco smoking from a peak of about 60% to now 17%.

    It’s clear that prohibition doesn’t work but these efforts did work- providing the information on risk , the tax (proven to be the biggest incentive to stop) the, message, stop tobacco subsidies and ads. We are now not a culture of smokers. So, why wouldn’t a Nationwide effort for an excise tax on proceed sugar, refined grains, sodium and vegetable fats along with all the other components of the tobacco model be as effective? It would.. The devil is not in the details. The devil is profit and policy.

    Addiction to sugar, fat and salt, tobacco and other substances will not be eliminated. But, we have the knowledge and the models to do a far better job in reducing this crisis in of preventable sickness and unsustainable health care costs. Sure, mental fitness and resilience is a big part of the solution but we absolutely must reform our eating culture to fully reform health care. It is a public health issue.

    The goal must be to have vegetables, and low glycemic fruits widely accessible and affordable while educating folks on how to prepare them for maximum taste. The Standard American Diet is a huge money maker and one of our biggest exports. The health of populations of other countries is showing the results.

    It will take time and money and that is why we need an excise tax – on sugar,/refined grains, added salt, and Omega 6 vegetable oils, trans fats, highly processed cheese, and corn fed animal meat (all of it).

    The folks who are in most need to be helped into mental fitness and resilience will continue to be hostage to the trappings of poverty/low income life until we reform both our eating culture and truly reform our health care.

  • meyati

    You can lead a horse to water but you can’t make it drink. I think that peer pressure is the most significant influence on health and eating habits.

  • John – InternationalVaporGroup

    Agree with that, smokers do know that tobacco is killing them but still they smoke.

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