Health by Default

Sometimes people use the expression "It was like rolling off a log," to mean that something is very easy to do.  It is not often that we would use that expression for health promotion.  Often individual effort to change or health promotion as a professional activity is difficult at best.  It takes relentless effort to bring about individual and community change in health status or behavior.  There is no doubt that these efforts can be successful, but it requires someone to keep on keeping on.

With that background, I want to write about what is called the "default option."  We have created communities in which the unhealthy option is the path of least resistance.  For example, when you order a restaurant salad, it often comes with cheese, croutons, bacon, and a generous portion of regular salad dressing.  What if instead, the salad automatically came with just the vegetable ingredients with low fat dressing on the side, so that a customer would have to request the other ingredients.  That's the default option.  What happens routinely is default.  Because health practices are often not supported by default conditions, health promotion has begun to think of ways to make the default option the healthier option.

Here is a different example.  A couple of years ago I was in Washington, D.C. attending a conference.  Several times a day I would walk the same route between the conference location and my hotel, and I began to notice that I would have  to stand several minutes at a number of street corners, waiting for the traffic to stop and the crossing signal to go on.  Meanwhile, the traffic lights were synchronized to facilitate the steady flow of cars, with minimal wait times at intersections.  It may be an impossible dream, but can we envision a city in which pedestrian flow is what takes priority; instead of making walkers wait, we make cars wait?  And in fact, instead of using the lion's share of our transportation funds for accommodation of vehicle traffic, we shift those funds more and more toward making it easier and more inviting to walk, bike, and skate as transportation?  Could we make walking the default option, while driving a car requires a conscious and determined decision?

In most public buildings of more than one floor, usually very close to the front entrance is an elevator.  This is the default option.  To take the stairs you have to be determined, going out of your way to search for the stairwell's location.  Once you are on the stairs, often there is poor lighting, no heating or air conditioning, poor housekeeping and sometimes a feeling of poor security because of an isolated location.  Could we turn this around, to make the stairs the default option?  What if we designed buildings so that upon entering, a person's eyes are immediately drawn to an attractive set of stairs, featuring bright lights, mounted art work, clean surfaces, and perhaps piped in music?

The general concept is to find ways to make the health promoting choice the easy automatic choice.  This could be applied to eating spaces, exercise resources, green lifestyles, driving safety, and many other issues.  Creative health promoters can find many ways to introduce default options into multiple-strategy health promotion programs.  Defaults tend to define social norms, so that with concerted effort to change defaults toward health promotion, social change will come about.

Here is an example of this last point.  When I make plane reservations through internet travel services, almost always, the sites will try to bundle a hotel reservation with the airfare.  If I choose to go forward, they will then present a list of hotel choices; the hotels offered and the order in which they are presented on the screen may be based on distance from the airport, commercial agreements between the airlines and the hotels, or other factors programmed into the travel sites.  What if the hotels presented were selected because of the health quality of their food services or their convenience to public transportation or the presence and nature of fitness facilities on site?  Over a period of time, the hotels would begin to change in response to this commercial incentive.  This represents social change, and that is what will ultimately bring about a more physically fit population.

There may be many issues with which the default function doesn't really work.  However, the biggest barrier to its use right now is that health promoters have not used much creativity to explore the option.  I hope that will change in the future.