Diseases linked to smoking tobacco, a lack of exercise, drinking alcohol and eating unhealthily are on the rise, even though we have more information than ever before on the risks involved. All indications are that these so-called “lifestyle” diseases are defeating efforts to persuade people to make the right choices; maybe it’s time for a different approach. We make the case for a new style of “practice oriented” public health policy, a move which could amount to a significant change of focus for public health.
Models of behaviour change that dominate current public health policy, rest on the presumption that individuals are capable of making “better” choices for themselves on the basis of information received, and that their well-being is an outcome of the decisions they make. Contrary to this widely held and popular belief, research has shown that humans are only partly rational and calculating assessors of information. People often respond automatically and routinely to the demands of their immediate environment.
There are alternative approaches to health which focus on these “wider determinants” and that highlight the importance of social context, drawing attention to links between social class and patterns of unhealthy behaviour. While these approaches recognise that choices are restricted or determined by social structures, the focus on individual action, albeit constrained, remains.
Neither approach provides much insight into the patterned, routine and habitual ways people live their lives and neither has proved capable of dealing with the problems of so-called “lifestyle” diseases, and the patterns of non-communicable diseases, which follow.
While behaviour change interventions have had some limited success, the spectre of lifestyle disease is a grim reaper indeed – and will continue its devastating journey unless we can effectively build on new ideas.
Trying to get individuals to adopt healthier lifestyles overlooks the fact that smoking, exercise and eating are fundamentally social practices: they have shared histories, they are shaped by businesses and institutions and they are not simply expressions of personal choice.
The contention that public health can and should take social practices as the central focus of action is informed by a set of ideas which have a long-standing history in the social sciences and which have already been taken up to good effect in other areas, such as environmental change.