Dyed-in-the-wool health promoters, on either side of a graduation are familiar with a theory called the Transtheoretical Model, sometimes also called stage theory. There are just a few basic ideas needed to understand this theory. People are at different points of readiness to change any particular health behavior: some are not interested in making a health-related change, some are in the process of changing, and some are trying not to relapse in their change. The corollary is that health promoters must tailor their intervention efforts to the varying needs of people at different levels of readiness. I want to relate this theory to New Year's resolutions.
It is customary for people to make pledges for self-improvement when they turn the calendar for the new year; often the intentions are health-related. Usually a price will be paid in doing something that takes discipline, changing time and schedule, and requires flexibility by significant others. This tradition is still a good one: Surely it is better to say "This year I want to quit smoking!" as opposed to "This year I want to put on 75 pounds!" The problem of course is that most people have trouble carrying out their pledges. Today we are one week into the new year and already the relapse curve is rising. Why is it that doing good things for ourselves is so difficult?
We can think about this in terms of the Transtheoretical Model. People who decide to make health-related changes are in a stage of readiness in which they are thinking about reasons to change and the benefits and barriers of doing so. They are in that stage because of personal life events and broader social influences. It is just by chance that their inclination to change coincided with the custom of New Year's resolutions. Health promotion agencies should be preparing people in November and December, so that when January rolls around they are in a frame of mind supportive of change. This does happen, but the effort is not extensive enough to reach most people.
Continuing the theme of resolutions and theory, people more times than not will relapse. It is not that the pledges were not genuine. It was that they don't have the supports to move to the next levels of stage theory. In order for people to act on their intentions, they need to have access to resources and must learn competencies and skills. People are genuine when they say they want to lose 25 pounds in the new year. What is lacking is a way for them to learn the necessary skills, such as how to grocery shop, plan meals, eat in restaurants, and obtain social support in ways that advance losing the weight. Do they have access to safe places to exercise? Without those things, their motivation isn't channeled into positive action.
Another problem is that for many health-related changes, once the change is made and the goal is attained, communities don't provide resource and motivational ramparts to sustain the achievement long term. We may say let people take care of their own stuff, and that is a legitimate point of view. On the other hand, without communities taking a role in helping people, we can expect to see lots of health promotion relapse. That is a choice society makes, but at the present time it is not an informed choice.
If you are a consumer trying to change, look for help in the surrounding community. If you are a health promotion advocate, be the change you want to secure.
Friday, January 7, 2011
Monday, January 3, 2011
Health Promotion 2011
The turn of the calendar from one year to the next often is accompanied by looking backward and looking forward. Today I want to look forward to things that I think will happen in the world of health promotion. Based on events in the world of practice and current trends and events, these are things I think we can anticipate happening, having an impact on health status and health promotion practice in the U.S.
Texting and driving will be a developing story. As texting is still on the upswing, more and more states and communities are taking action. Journalists will be looking for results from the various efforts to discourage texting while driving. There will be more public education addressing cell phone and driving safety, such as the current PSA developed by the U.S. Department of Transportation.
It may be that the ultimate solution will be a technological one. For example, what if there was a way for cell phones to interact with a car's electrical system, so that while the car is moving, outgoing calls and all texts, in and out, were blocked? In coming calls could be received, but for all other cell functions, the car would have to be parked. Perhaps phones would come with a pre-installed app with a GPS function detecting motion. As long as the car is moving, all phone functions are disabled. These ideas are only speculation, but today's theme is the future in health promotion. This whole story is fascinating to watch, and will present many new ideas for health promotion practice.
Another area I would like to make predictions about is the campaign against overweight and obesity. There will be on-going public education in multiple venues and formats: school instruction, mass media, patient education, workplace health programs, and so forth. Most of this education will be only modestly effective at best. This is due to several factors working against relevant diet and exercise behavior change. First, current patterns of physical activity and nutrition are deeply ingrained in the culture and social norms, making change much more difficult. Next, there is huge opposition from food and beverage makers and fast food vendors - sugar, fat and empty calories represent massive profits. These corporate interests will work as hard as possible to counteract the health promotion messages. Finally, our success in reversing overweight is abysmal. Many people lose weight, but the segment of dieters who lose weight permanently is very small. The state of the art and science of weight loss is still primitive. There is no reason to expect this to dramatically change in the near term.
The real action with respect to the anti-obesity campaign will be with policy solutions. This is going to heat up in 2011, because many politically conservative leaders and organizations are starting to push back against what they see as "nanny state" over reach by big government. For example, in December of 2010, President Obama signed into law the Healthy, Hunger-Free Kids Act, which among other things establishes nutritional standards for foods regularly sold in schools. One side sees this as a way to improve the nutritional status of children while the other side thinks it tramples on local control of schools and the prerogatives of parents. The intensified focus on the obesity epidemic is going to collide with conservative ideology, and this will be seen more and more in 2011 and going forward.
A final issue that seems to be heating up is the use of smokeless tobacco, in the form of mouth-absorbed tobacco (e.g. Snus) or electronic cigarettes. The only reason this is coming up now is that tobacco companies are redoubling their efforts to sell products, and because the door is increasingly closed on conventional cigarettes, these other options are seen by Big Tobacco as viable alternatives to support their business.
There are undoubtedly going to be many other health challenges coming to the forefront in 2011. For example, I wonder what will happen this year regarding 1) climate change and 2) pandemic flu? One of the things that makes health promotion always interesting is the parade of new issues always coming along. Stay tuned.
Texting and driving will be a developing story. As texting is still on the upswing, more and more states and communities are taking action. Journalists will be looking for results from the various efforts to discourage texting while driving. There will be more public education addressing cell phone and driving safety, such as the current PSA developed by the U.S. Department of Transportation.
Another area I would like to make predictions about is the campaign against overweight and obesity. There will be on-going public education in multiple venues and formats: school instruction, mass media, patient education, workplace health programs, and so forth. Most of this education will be only modestly effective at best. This is due to several factors working against relevant diet and exercise behavior change. First, current patterns of physical activity and nutrition are deeply ingrained in the culture and social norms, making change much more difficult. Next, there is huge opposition from food and beverage makers and fast food vendors - sugar, fat and empty calories represent massive profits. These corporate interests will work as hard as possible to counteract the health promotion messages. Finally, our success in reversing overweight is abysmal. Many people lose weight, but the segment of dieters who lose weight permanently is very small. The state of the art and science of weight loss is still primitive. There is no reason to expect this to dramatically change in the near term.
The real action with respect to the anti-obesity campaign will be with policy solutions. This is going to heat up in 2011, because many politically conservative leaders and organizations are starting to push back against what they see as "nanny state" over reach by big government. For example, in December of 2010, President Obama signed into law the Healthy, Hunger-Free Kids Act, which among other things establishes nutritional standards for foods regularly sold in schools. One side sees this as a way to improve the nutritional status of children while the other side thinks it tramples on local control of schools and the prerogatives of parents. The intensified focus on the obesity epidemic is going to collide with conservative ideology, and this will be seen more and more in 2011 and going forward.
A final issue that seems to be heating up is the use of smokeless tobacco, in the form of mouth-absorbed tobacco (e.g. Snus) or electronic cigarettes. The only reason this is coming up now is that tobacco companies are redoubling their efforts to sell products, and because the door is increasingly closed on conventional cigarettes, these other options are seen by Big Tobacco as viable alternatives to support their business.
There are undoubtedly going to be many other health challenges coming to the forefront in 2011. For example, I wonder what will happen this year regarding 1) climate change and 2) pandemic flu? One of the things that makes health promotion always interesting is the parade of new issues always coming along. Stay tuned.
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