SECOND OPINION:Telling people what to do doesn't change their behaviour, writes JACKY JONES
MY NEW YEAR’S resolution for 2012 is to ignore all lifestyle advice. There are so many new reports on obesity, diabetes and heart disease that I feel bored to death with it all. Lifestyle recommendations have been the same for at least 30 years – eat healthily, drink less, exercise more and give up cigarettes – and things have just got worse. Levels of obesity and diabetes are increasing every year, regardless of public health education campaigns and all the lifestyle advice from health experts. Children are now being blamed for eating too much and not taking enough exercise. Growing Up in Ireland, published last November, reported that a quarter of three year olds have weight problems.
In December, the European Heart Network (EHN) published Diet, Physical Activity and Cardiovascular Disease Prevention in Europe. This disease is estimated to cost the EU more than €100 billion a year for healthcare and at least €80 billion on lost productivity. The report describes the drastic lifestyle changes Irish people need to make over the next five to 10 years. Wholegrain cereals, fruit and veg, and peas and beans should make up at least 75 per cent of our food intake. Physical activity levels need to increase from the current minimum of 150 minutes a week to 300 minutes.
Ireland is doing worse than many other countries in relation to the consumption of fruit and veg. The supply of these products varies dramatically from country to country. Mediterranean countries supply 900g per person per day whereas Ireland provides just over 500g. People need 400g-600g of fruit and veg every day so, allowing for waste when they are peeled, 700g-900g of fruit and veg per day have to be supplied. Ireland is just not growing enough of these products and the undersupply means these foods are too expensive and less available.
All the recent reports that describe chronic health problems agree on the solutions, which are comprehensive public health policies that address poverty, educational attainment and the environment, and not lifestyle changes by individuals. These solutions must be implemented by policymakers and planners, yet every time a lifestyle-related report is published, serious-faced medical and nutrition experts are rolled out by the media to comment on the findings.
These experts know very little about developing and implementing public policy and even less about behaviour change. The usual response from health professionals is to give useless advice and urge behaviour changes. The people who should be asked to comment on lifestyle reports are planning and environment experts.
Constant advice about lifestyles does not change anyone’s behaviour and can have the opposite effect. People become habituated and immune to the messages if they are overexposed to them and eventually pay no attention at all. Sensitivity to risk-factor messages means that people become increasingly anxious about the hazards in their lives and feel powerless.
Negative lifestyle messages lead to stigmatisation, victim-blaming and health inequalities. Discussing obesity and diabetes as if these problems are the individual’s fault stigmatises people with weight problems. Everyone may feel fearful when listening to health experts being interviewed about the latest lifestyle report, but only those in the higher socio-economic groups are able to comply with the message to, say, eat more fruit and veg. Poor people stay scared with no way of alleviating their fear. Telling people to exercise more is pointless if they live in an area with no facilities and no footpaths.
Lifestyles will change en masse when the Government develops effective public policies on food and the environment. Changes are needed in the physical environment to automatically allow movement, rather than requiring a conscious decision on the part of individuals to behave differently. Healthy food needs to become more affordable, accessible and available. Laws are needed in relation to fast-food outlets. One well-known fast food supplier had only one outlet in Western Europe in 1971 and now has over 6,000.
The highest priorities in the EHN report are reducing the consumption of meat and dairy products, reducing the consumption of food of low nutritional value such as sugary drinks, and reducing food waste.
Unfortunately, these goals are in direct opposition to current economic policies which are based on getting people to consume more. EU and Ireland’s economic policies need to be brought into line with EU health goals. So forget about your lifestyle for 2012 and lobby politicians instead.
Dr Jacky Jones is a former regional manager of health promotion with the HSE