The language of public health needs a healthy swap

Do you agree with this statement? We need to direct obese people to evidence based interventions which teach them about a healthy diet, exercise, and their health risks.

If so, then please read on.

A report published today in the BMJ confirms what we all know to be true, the received wisdom on tackling childhood obesity is wrong. The research show that a conventional education based programme of diet, exercise and cooking lessons showed “no statistically significant effect on BMI score or on preventing childhood obesity.” We all know that this is the story nationwide, and there’s no doubt we need changes to the food system, our environment and junk food marketing but that shouldn’t distract from the fact that the received wisdom for public health programmes doesn’t work.

At Living Loud we are communicators, architects of behavior change and we believe we need to start changing the languages and the thinking.

Here’s our top language swaps

Evidence > Understanding

It feels like evidence has become an end in itself. Most of that evidence is based on flawed artificial environments of small scale tests and poorly thought our qual research. As Nobel winning economist Daniel Kahneman said “we think much less than we think we think”, and it’s true, particularly when it comes to decisions on food. If you ask people what they think, and you get an answer which is different from the truth.

Read more: Why the science of nutrition is so messy, Vox, 2016 (excellent article)

The marketers rule is to only ever ask people about the problem, don’t ask about the solution – Henry Ford famously said that if he had asked his customers what they wanted they would have said faster horses. We need to move the focus from evidence, to understanding. Do we understand the problem? In medicine evidence is paramount; this isn’t medicine, it behaviour change and in behaviour change its understanding which counts.

Understanding, of course, comes from listening. As Dale Carnegie summarised in his 1936 book “How to win friends and influence people”, “the only way on earth to influence the other people is to talk about what they want and show them how to get it”

Fear > Hope

So much of public health seems to rely on fear of tomorrow to motivate people. If you don’t change your lifestyle bad things will happen. Fear has never been as great a motivator as hope. If we present healthier choices as the cure, they become a medicine, and we believe medicine to taste terrible. If you focus on hope, then healthier choices become an enchanted elixir. It is more appealing to reach for a reward than run from a risk.

Health > Happiness

In marketing we believe that most people see health as an enabler of happiness, rather than as an end to itself – we need to offer a pathway to happiness. If you look at good advertising for “health” products such as Special K, it sells a vision of a future you; thinner, more relaxed and happier.

As Albert Schweitzer, the French-German Theologian so wisely put it “Happiness is nothing more than good health and a bad memory”, and I think I can squeeze the Dalai Lama in here “Happiness is the highest form of health”. Perhaps Public Health England needs to a rebrand, Public Happiness England, now that would be a game changer.

Knowledge > Inspiration

Ahhhh knowledge, the answer to all things, if only they knew. The single biggest issue we have with public health is the idea that knowledge alone will solve anything.

Knowledge only reveals the destination, inspiration is the power to get you there.

The usual dose of fear of horrible disease combined with knowledge on diet and exercise without giving people the means to succeed lies at the heart of this systemic failure. By means, we’re not talking cooking lessons, access to fresh vegetables and green spaces, those essential tools will just lay unused until we talk to the heart. If you give people fear and knowledge without the emotional means to succeed you just highlight their own failure, which leads to despair which then leads to large tubs of ice cream.

This quote from the philosopher Bertrand Russell should be painted in the walls of every health centre.

Complex > Simple

People seem to be confusing complex with difficult. There is nothing complex about obesity – people need to eat less junk food and be more active – simple. It’s difficult because of the obesogenic environment, junk food marketing, lack of cooking in schools, political will etc etc.

Here’s rule one of the PR playbook – if you want to stop anything happening make it complicated. Those that wish to protect the status quo are feeding complexity into the system, and if you really want to change it you need to resist their every attempt. Simple gets done, complicated gets discussed.

At this point it’s a tough choice for a quote between Dr Seuss and Confucius, I’ll leave you to decide who said what: “Sometimes the questions are complicated and the answers are simple” and "Life really is simple, but we insist on making it complicated".

Direct > Choose

We all agree that we want people to take control of their health, but how can we expect people to take control if we give them no choice. If the only option we present is a “10 week programme every Saturday at 3pm at the local school” then we have just reinforced their abdication of responsibility.

How can we expect people to take control until we empower them to choose?

People > Person

People are different. Not just socio-demographically, but physiologically, emotionally and culturally. To succeed are countering obesity in a child, a family needs to recognise they have a problem, they need to feel safe from blame and judgement, they need to have the desire to change and the belief that they can and then they need the time, money and access to facilities to make that change. Only then is nutrition, diet, activity programmes or cooking lessons relevant. Unless we understand the individual family and we are in position to use that understanding to adapt our response to their needs are we unlikely to succeed.

Albert Einstein once said that to solve a problem you need to spend 55 minutes thinking about the problem and only 5 minutes on the solution. We’d like to see public health spending less time designing interventions and more time putting people before policies. He also said that doing the same thing over and over again and expecting different results is insanity.

So in the spirit of trying something different can we suggest a new statement?

We have a responsibility to listen and seek to understand each person’s hopes so we can inspire them to embrace their own food and active lifestyle choice to enjoy a fabulous life.

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