Why ‘Lifestyle disease’ is misleading

Individual choice as the primary driver of wellness is a central idea in the mythology of modern health[1]: we label non-communicable disease ‘lifestyle’ disease, and target our interventions at an individual’s behaviour like diet and exercise. Our underlying idea is that ‘if only the individual changed their behaviour, then their health would change too’.

Is it really that simple though?

Although broad-scale health education tactics like the ‘Life: Be in it!’ campaign of the ‘90s can create real impact, especially in more affluent communities, we forget that most individuals have limited power over their lives.

“We forget that by ourselves we cannot change the toxicity of our water supply, nor the quality of the air we breathe.”

We don’t necessarily get to choose how many hours we sit at a desk or how many junk food advertisements we view in a day. We forget about the role of workplace bullying on mental health, and the widespread prevalence of endocrine-disrupting chemicals. We downplay the psychological stressors of our post-human pace and the how rushing all day can demotivate one to go for a run. We forget that by ourselves we cannot change the toxicity of our water supply, nor the quality of the air we breathe. We have finite influence over the brands of food stocked on our local shelves and the production processes from which they were sourced. We forget the cumulative effect of these challenges to our wellbeing – especially if we come from a place of privilege.

In vulnerable communities, the unhealthy socio-economic environment can make lifestyle changes alone difficult and limited in impact. We must remember that storehouses of hazardous waste tend to be disproportionately situated in poorer countries and areas, and nutritionally dubious ‘food’ is more likely to be found in marginalised communities. That in a time of vested corporate interests having no money is almost synonymous with having no voice, and that powerlessness is almost always associated with poorer health outcomes.

To disregard these systemic issues and champion lifestyle changes alone is both myopic and unfair. It would be yet another kind of ‘victim blaming’; a convenient way of absolving governments and corporations of responsibility and of ensuring that lifestyle diseases are the someone else’s problem. Not only is it unfair, it’s ineffective: evidence shows that health promotion programs that narrowly focus on single lifestyle changes without considering the social and physical environment in which those behaviours occur, are often fruitless[2] – and, at worst, they can perpetuate the inequity they aim to repair[3]. Even reallocating health services to vulnerable communities are limited in their capacity for transformative change[4].

“There’s limited impact from a cooking class, if when the participants return to ‘real life’ they can’t afford fresh food or struggle to motivate themselves in the midst of stressors.”

What we need instead is an approach that provides health care and health education alongside the creation of healthy environments. There’s limited impact from a cooking class, if when the participants return to ‘real life’ they can’t afford fresh food or struggle to motivate themselves in the midst of stressors. If, however, the individual is entering an environment where they are encouraged to adopt health-promoting behaviours and are given long-term support, the likelihood of transformative change is much greater.

Basically, the term ‘lifestyle diseases’ becomes problematic when it leads to a false attribution of blame – when it is used to shift focus away from the social, economic and environmental factors of ill health and onto the individual. When we use the term ‘lifestyle diseases’ we need to remember the myriad factors that create a life, and to adequately address these social determinants in any health program we create.

[1] Bloom cited in P. Zimmet et al., ‘Global and societal implications of the diabetes epidemic’, American Nature, 414/6865 (2001), 786.

[2] P.A. Braveman et al., ‘Broadening the Focus: The Need to Address the Social Determinants of Health’, American Journal of Preventative Medicine, 40/1 (2011), 9.

[3] P.A. Braveman et al., ‘Broadening the Focus: The Need to Address the Social Determinants of Health’, American Journal of Preventative Medicine, 40/1 (2011), 9.

[4] The Royal Children’s Hospital, Place Based Initiatives Transforming Communities: Proceedings from the Place-based Approaches Roundtable (2012), 8.

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