PREVENTIVE MEDECINE: PEOPLES AND RESPONSIBILITY FOR HEALTH
How can one go about changing personal health behaviour, especially among those whose motivation is low? One way is to control everything by law. Although many of us would resist this idea, our lives are already controlled far more than we often realize. Laws already control certain health behaviours, but where legal regulation is not possible or advisable progress will depend on individuals altering their behaviour and the provision of skills to enable them to do so. Beliefs, however well founded, are not enough in health care and prevention. The individual needs to be motivated or he or she will not be able to make anything happen. The classical gag is that of the man who is so convinced that his smoking will kill him that he continues to smoke to relax him when he thinks about it. Studies on persuasion show that beliefs usually precede motivation in the change process and that it is important to know the stage of knowledge any target group has reached before trying to persuade them to do something. Almost everyone knows that smoking is harmful to health yet millions are not sufficiently motivated to stop. Such people need to be convinced that the future health reward is worth the short-term pain of stopping smoking; that the unpleasant consequences of stopping smoking are not as bad as they think; and that there are advantages in the present to stopping smoking that they had not even thought of. Once such people realize these things they become motivated to do something about their smoking.
But many people are well-motivated yet haven’t the behavioural skills to do anything about it. They need to learn skills to bring their smoking behaviour under conscious control.
Wherever we look around the world, and whatever the health practices we look at, the diffusion of information, ideas, beliefs and behaviour follows a predictable pattern that is roughly S-shaped. At first only a few people take up the new beliefs or practice while those around them discuss them and look out for the consequences. Soon others take them up at an increasing rate. Perhaps the major factor that determines this acceleration is the intensity of communication within the population. Self-help groups and other consumer networks are very powerful agents of change and research has found that people who make a public commitment to a health goal are far more likely to make the change required than those who don’t. This is because we live within social networks in which we share beliefs, attitudes and behaviour patterns, and once groups become at all formalized people’s loyalty to the group overrides almost any other consideration. The evidence that this is so has come from stop-smoking and weight-loss groups that have disbanded. Members backslide very quickly. Viewed this way, it seems that few of us act truly independently.
Whether in groups or in individual cases, fear is often used as a way of changing people’s attitudes, motivation and behaviour. Making people afraid of certain consequences of their actions is cruel, though, unless at the same time they are told how to protect themselves from the feared result. Some so-called sex education, especially in schools, has in the past done little more than induce in the recipients a terror of VD. This sort of scare tactic alone obviously isn’t enough-it does nothing to tell youngsters about how to handle their emerging sexuality, being limited to stressing the horrors of what might happen if they do have sex. Similarly, showing people pictures of lung cancers has only the most temporary effect on smoking habits.
Persuasion methods, whether they are face-to-face or through the mass media, are really only successful if they are accompanied by specific opportunities for putting more beneficial behaviour into action. Various studies have shown that mass media campaigns can alter beliefs and to some extent motivation but changing behaviour involves building up skills in people, and this can be difficult whatever their social class or level of education.
So far we have looked mainly at rational and conscious behaviour. It is in this context that we can understand, for example, why for many of us turning on the TV is a signal to eat and drink. The relaxing behaviour of the TV watching triggers another relaxing (self-pleasuring) activity-eating-and the two are seen as enhancing each other.
However, there is another whole side to human behaviour-the unconscious mind. And this plays a vital role in understanding the prevention of illness. Much of my description of illness behaviour lower down the social scale arises from the study of unconscious attitudes. Few people, in any socio-economic group, rationally argue through such things-they are simply an intrinsic part of their behaviour handed down from the unconscious minds of their parents. All of us are far more controlled by our unconscious minds than we realize. A good example I shall use to illustrate this point is the one of unwanted pregnancy.
To the logical, rational thinker there is no reason why, in the 1980s, any baby should be born unwanted, but the Family Planning Association estimates that about 200,000 of the 648,000 babies born in the UK in 1984 were ‘unwanted’, or at least unplanned. Contraception is available to all so why and how does this major preventive health programme fail so dismally? Surely someone who doesn’t want a baby, doesn’t have to have one, and can take steps to ensure that he or she doesn’t? It is true that no method of contraception is absolutely 100 per cent successful (though the combined pill, properly used, is virtually so), but it is quite wrong to think of the majority of unwanted pregnancies as simply due to bad luck.
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