Healthy Lifestyle: Strengthening the Effectiveness of Lifestyle Approaches to Improve Health

How Can Social and Community Processes Foster Healthy Lifestyles?

The limited success of earlier attempts to improve health through lifestyle education has shifted the focus for intervention from the individual toward more comprehensive approaches that address health as a social or community (shared) issue, and act on the social processes that influence personal behaviour. Placing the entire responsibility for change on the individual is now understood to be an insufficient response that blames the victim rather than addressing the social circumstances that lead to harmful behaviour. Indeed, social or community responses canadd resources to an individual's repertoire of strategies to cope with change and foster health (Lyons et al., 1998).

However, the community context can increase the likelihood that individual problems may occur. For example, as noted by Holder (1998):

"Alcohol-involved problems are not simply the results of actions of a set of definable high-risk individuals; rather, they are the accumulative result of the structure and interactions of complex, social, cultural, and economic factors within the community system.

This observation led Holder to develop a community systems approach to the prevention of alcohol problems which challenges the current individual level models of problem prevention in favour of an approach which sees communities as complex, dynamic and adaptive systems which can be modified to decrease the chances of individuals developing alcohol-related problems.

Community Level Interventions

The authors of this paper are not arguing for elimination of the notion of individual lifestyle, but for striking a balance between individual and social orientations toward this concept. Community level interventions modify the entire community through organization and activation, as distinct from interventions that are community based, but aimed at modifying the behaviour of individuals (Lomas, 1998). There is now widespread recognition of the importance of community level action to promote health by building social networks and creating social capital (Kawachi et al., 1997; Kawachi & Kennedy, 1997). Social capital is created from the everyday interactions between people in structures such as civic and religious groups, family membership, informal community networks, and in norms of voluntarism, altruism and trust. The stronger these networks and bonds, the more likely it is that members of a community will co_operate for mutual benefit. In this way, social capital influences health, and may enhance the benefits of investments for health (WHO, 1998a).

In the Healthy Community movement, communities have successfully created healthy "community lifestyles" by increasing green spaces and play areas, removing cars from downtown streets, improving public transportation, and building community centres, walking trails, and bikeways. The Healthy Toronto initiative involves city support for neighbourhood initiatives, including a self_help project for homeless people, an urban food project, a street safety initiative, and a clean air project that combines public education and action to reduce air pollution (Healthy City Toronto, 1993). A study by Weinehall et al.(1999) on a community intervention in Sweden for the prevention of cardiovascular disease concluded that combining individual and community/population approaches can also be effective in a rural setting. 

Community initiatives aimed at modifying the relationship between the individual and the environment hold great promise. These social ecological approaches have been shown to have a positive effect on health (Anderson, 1999; Glouberman, 1999; Stokols, 1996). Social ecological approaches view health as a product of the relationship between the individual and the environment, and focus on enhancing people's capacity to engage in and create their social environment. They are multi_disciplinary, with a strong citizen participation component. These approaches integrate individual and environment_focused interventions, and are embodied in initiatives such as the Healthy Communities movement, the Community Action Program for Children (CAP-C), John McKnight's asset_based community development (Kretzmann & McKnight, 1993), participatory action research, and many other community health promotion programs. Over the past decade, the Health Promotion and Programs Branch of Health Canada has supported hundreds of community based projects aimed at enhancing the capacity of individuals to engage in and shape their social environments.

Enhancing the scope for interdependence

Involves individuals interacting within their community as they address particular types of issues, and assist others in their community. As the scope of the problem being addressed becomes more complex, the level of action becomes more complex because people need more resources (chronic illness, for example). Therefore, knowing the level of collective action needed to effectively address an issue is an important coping skill. In fact, a healthy lifestyle might involve the acquisition of coping skills, the accumulation of coping resources, and the development of coping strategies from an interdependence perspective (See Lyons et al., 1998, for a fuller discussion of these concepts; also Israel et al, 1994, for a model of empowerment from the individual and community perspective).

Creating supportive environments

For health requires action at many levels, and may include political efforts to develop and implement supportive policies and regulations, sustainable community economic development, and social action.

Research has demonstrated that the involvement of "communities" in health promotion and disease prevention programs is critical. Communities and their members need to acquire the capacity for stronger health promotion and disease prevention roles. Capacity is the development of "community" infrastructure for health promotion and disease prevention and the commitment to use it for these ends. The process is multi_directional: a strong community culture that supports health increases the health of individuals; the commitment of individuals to foster health from a community perspective increases the well_being of all; and the interaction between the individual and community creates the ingredients for social capital, social cohesion, and resilience. Health becomes both an individual and a collective resource. Furthermore, the health of individuals and of communities improves the health of the nation (U.S. Dept. of Health and Human Services, 2000).

Clearly, building this capacity for health promotion and disease prevention at the community level should be an essential component of Canadian health services focused on "lifestyle". Community mobilization can bring together varied social units prepared to work collectively to achieve a greater measure of health for all citizens.

Key Points: Social and Community Processes to Foster Healthy Lifestyles

• Learning effective team skills should be an important feature of "lifestyle" training; e.g., leadership, cooperation, communication, social support strategies, collective coping and problem_solving strategies.

• Healthy lifestyles will be encouraged by providing opportunities to develop coping strategies and fostering resilience (individual and community).

• A healthy lifestyle incorporates a balance between individual autonomy and contributions to community.

• Community processes include providing training in skills that will help to build social capital.

• Social ecological approaches focus on building community capacity and citizen empowerment.

• A goal of healthy lifestyles is to enhance the scope for interdependence: freedom and opportunity within community.

• Resource optimization is important. Enhancing the scope for interdependence includes identifying the level of collective action needed to effectively address an identified issue.