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04/11/2010
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Reint-Jan Renes
Campaigns promoting a healthy lifestyle only have a modest or sometimes even a negative effect ('Campaigns against alcohol ineffective'). This was the gist of a report in the NRC newspaper early last month in response to a publication in The Lancet. According to the authors, the most important advice is: support campaigns with services or products and assess the impact in advance. Unfortunately, if this is the only aspect set to change, the next few decades will probably see very little change. The successful anti-smoking policy implemented in the Netherlands and many other European countries is a good example of how it should be done.
The main problem with the current lifestyle campaigns has nothing to do with inadequate assessments in advance or products that may or may not be provided; the problem is the excessive focus on knowledge, awareness and motivation. Research has shown that these factors only play a minor role. People are only rational to a small extent and usually act impulsively, on the basis of subconscious processes. This is certainly true when it comes to eating, exercising and alcohol. People have an inner urge for unhealthy behaviour and are confronted with a feast of unhealthy temptations in their immediate surroundings. Lifts and escalators make life easier, you don´t have to walk far to find a snack and a
glass or two of alcohol cannot be avoided in social situations. The physical and social ('obesogenic') environment makes it almost impossible for people to opt for a healthy lifestyle. Unhealthy is the default option. By trying to impress upon people that it is not sensible to drink too much alcohol or that they should spend at least 30 minutes a day exercising, the campaigners are overestimating the extent to which people reflect on their personal choices.
Social psychological experiments have shown that when people have too little time or no opportunity to think about their choices, they almost always subconsciously choose the unhealthy option. In a society that offers little time for reflection but plenty of opportunity for unhealthy indulgence, it is hardly surprising that we are eating and drinking to excess and becoming steadily more obese. The best solution would seem to be clever marketing of healthy choices (for example; the success of sweet snack tomatoes among young people, changing the physical environment, such as making the school canteen a healthy place to eat). Government interventions, such as past lobbies for banning advertisements for sweets aimed at children, are good examples of a more promising approach. In short, there must be a way of making a healthy choice both easier and more attractive to the majority of people, and making the unhealthy option either very difficult or impossible. Evidence of the success of this strategy can be seen in the anti-smoking policy: people must now make a physical effort and overcome a psychological barrier to make a conscious decision to smoke. Not smoking has become the default option. In the countries around us where the policy has been in place for longer, such as Italy, England and Scotland, there has been a significant drop in the incidence of smoking-related health problems.
So if campaign organisers really want to bring about change, they should concentrate less on the rational, autonomous side of people and pay more attention to the critical, tempting moments at which the irrational, conformist side is unable to suppress their impulses.
Reint-Jan Renes
Associate Professor of Health Communication
This text was also published in NRC Handelsblad on October 16, as a letter to the editor