Michael Kelly and Mary Barker from the University of Cambridge and the University of Southampton have just published a fantastic article in the Journal of Public Health – “Why is changing health-related behaviour so difficult?” – that conceptualizes in a very accessible way why changing health-related behaviour is so difficult and what we do wrong in no acknowledging it.
This article – is compulsory reading for all those who for years have been researching effective health strategies to prevent the rise in obesity, tobacco o alcohol consumption or promote physical exercise. It is worth reading for all those outside the public health field who are trying to design new change strategies for instance against climate change or for the introduction of new technologies in the classroom.
We are all convinced that changing behaviours is essential to respond to the health epidemics (type 2 diabetes, cardiovascular disease…) affecting hundreds of millions and also puzzled by the fact that we are having a hard way achieving it (and bringing evidence)
The authors draw attention to six errors policy makers (and often we as education specialists) apply to health-related behaviour change in non-communicable disease prevention;
error 1. It is just common sense
“It is obvious what needs to be done, so let us just get on and do it”.
If changing behaviour was simply about making common sense simple changes and good choices then we would all be able to make whatever changes we wanted to whenever we wanted, but we do not.
Just because something appears to be obvious and simple does not mean that we should not bother to study it
error 2. It is about getting the message across
“If we could only get the message out there in some form which people could understand and identify with, then they would change in response”.
The investment in social marketing campaigns which borrow heavily from the commercial analogy and their lack of tangible success suggests that the commercial analogy is flawed if applied simplistically to public health matters. Campaigns can have an important role and can be effective, but they are but one part of a total strategy and behaviour change is not just about simple messaging.
error 3. Knowledge and information drive behaviour
“If we tell people the negative consequences of eating too much or exercising too little, they will change their behaviour accordingly.”
This is clearly not true and every front-line clinician and practitioner knows it is not true.
error 4. People act rationally
“If you tell people what is good for them and what they need to do to protect their health, they will do it”.
Most diets fail, not because people do not know what is supposedly good for them, but because knowledge and its rational assessment alone do not drive behaviour.
error 5. People act irrationally
“People have their own reasons for doing things”.
When someone with asthma refuses to stop smoking, we might regard them as very foolish or addicted or both. But what we tend not to see is that this may not be so irrational a decision after all given their lives and experiences.
error 6. It is possible to predict accurately
“We can say with certainty how individual people will behave in any given situation”.
While we can patterns of health inequalities, tobacco and alcohol consumption and trends in these over time and place in great detail, however, none of this has provided sharp-edged tools with which to tackle health inequalities, the obesity epidemic or the rising tide of alcohol consumption.
As a conclusion, the authors advocate to rethink the way health professionals work with the public. They insist on the need to steer away from information giving and towards empowering and motivating individuals to generate their own solutions to their problems.
At P.A.U. Education with the Avall project, jointly with Bjarne Bruun Jensen from the Steno Health Promotion Research (Denmark) and Esteve Llargues – the project’s designer and coordinator – from the Granollers General Hospital (Spain), we designed an educational intervention during childhood viewing children and schools as catalysts for health-promotion actions at community level and that could provide a key prevention strategy, with education on dietary habits and physical activity for children and their families being considered the foundation for healthy lifestyles in adulthood. Two years after the study completed, the intervention group showed a lower increase in BMI and the trend consolidated after 6 years.
Mark Hanson’s recent research from the University of Southampton has revealed the importance of healthy lifestyle in parents in the period before they conceive a child. This time in the life course offers a window of opportunity to reduce the risk of later NCDs as well as childhood obesity in two or more generations simultaneously – in parents and in their future children and possibly their grandchildren.
These examples help envision new effective intervention strategies that can only work with the active support and conviction of policymakers…
Back to school! A full school year is ahead of us and many countries experienced “innovative” school reforms. Does it make sense to change again and again our school programs, school standards…?
Educative systems are accustomed to change. Some would say that they are in a state of constant change. Over the past 30 years, all European countries for instance have been continuously engaged in a deep reflection regarding the future of their educative systems. The rhythm of these organizational and curricular reforms during this period more than doubles that experienced since the turn of the 20th century. Are we simply facing yet another cycle of change that will yield to a set of new reforms? Will it constitute a “controlled” change to adapt schools to new technological, social and economic conditions? Or are we on the edge of a true revolution?
Over 20 years ago, Seymour Papert argued that: “children will (no longer) sit quietly in school and listen to a teacher give them predigested knowledge. They will revolt.” The revolt didn’t take place at the time and our schools didn’t change (much).
There are several good reasons to think that times are now riper for a “revolt” of great magnitude. In countries like Spain or Portugal, more than 30% of early school leavers and more than 40% of unemployed youth aged over 18 throw the very meaning of school education into question. In the USA, we have just witnessed the first cases of higher education students filing a lawsuit against their law school for creating false expectations with regards to their future employability.
In this context, does it make sense to make school reforms as if we were trying to make up for some problems without changing the whole picture? Have we still time to adapt our school education systems in order to prevent resounding failure? Or should we totally rethink school education in a much deeper way?
The failure of our societies to provide work to youth and to fully integrate them into society may mark the end of school education as we know it until now: a continued process that should lead children and youth to progressively gear up for their futures as successful professionals and responsible citizens.
Policymakers that keep changing the schools without changing the life perspectives for young people may listen again to Bob Dylan:
“There’s a battle outside
And it is ragin’
It’ll soon shake your windows”
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