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

Introduction

A healthy lifestyle is a valuable resource for reducing the incidence and impact of health problems, for recovery, for coping with life stressors, and for improving quality of life. However, convincing Canadians that health is a good investment, and providing guidance and incentives to create a culture that fosters health, are complex processes. How do we direct efforts to engage people in becoming and staying healthy?

Illness is costly. It takes considerable family and state resources to cope with and to ameliorate health problems. The increasing prevalence of chronic illness and disabling conditions, along with greater life expectancy and the rising average age of the population, are substantive contributors to the rising burden of illness. Conditions such as heart disease, cancer, diabetes, joint disease, and mental illness are responsible for the vast majority of death and disability. Currently, we rely almost exclusively on the provision of clinical care by highly trained health professionals as our major strategy to deal with these conditions (MacLean, 2000). However, the aging of Canada's population suggests that problems in the provision of health care will likely worsen unless action is taken now to promote health and prevent illness. Action must include the development of more efficacious alternatives to the present reliance on health care services as the response to illness.

Many health problems can be prevented or at least their occurrence postponed (U.S. Dept. Of Health & Human Services, 1999; IUHPE, 1999; Stroebe & Stroebe, 1995). We have known for the last 20 years that a sizable proportion of the 10 leading causes of death is due to potentially modifiable social and lifestyle factors (US Dept. of Health & Human Services, 1999). Some health issues are addressed with relative ease (e.g., wearing seatbelts). Many others such as exercise, nutrition, smoking, and substance abuse are integrally linked to culture and to socio-economic status ( Kawachi et al., 1996; Labonte, 1998; Lupton, 1994; Marmot et al., 1997; Stewart et al, 1996), and are much more difficult to address. Evidence has shown that many of these health-related personal and social factors are subject to modification, but only through comprehensive, intersectoral, long-term strategies that employ a variety of health promotion and disease prevention approaches (FPT Advisory Committee on Population Health, 1994; Frolich & Potvin, 1999; Hobfoll, 1998; Hyndman, 1998; Lomas, 1998). Many of the behaviours that contribute to health conditions, whether good health or ill health, are clearly related to the interdependence between people's lifestyle and their social environment (Bhatti, 1999; Frankish & Bishop, 1999). We are just beginning to understand the concepts of social integration, social support, and interdependence at the same time that health promotion strategies focused purely at individual health behaviors are yielding limited success (Coyne & Fiske, 1992; Frohlich & Potvin, 1999; Glouberman, 1999)

Purpose and Structure of this Paper

The purpose of this paper is to examine and re-construct the concept of "healthy lifestyle" so that the term can be more usefully applied in our approaches to health promotion and population health. As our society evolves, so too do the concepts we use to understand and act on the world around us. The concepts of "lifestyle" and "healthy lifestyle" have changed and are changing. Painting a picture of these terms for the year 2000 and developing strategies to improve the health of Canadians through healthier lifestyles must align with our knowledge base about health and its determinants, and the evidence we have accumulated about the effectiveness of strategies to improve health.

This paper is structured around the following questions. Is "healthy lifestyle" a useful concept? What are the determinants of lifestyle choice? What approaches have been used to promote healthy lifestyles and have they been effective? How can social and community processes foster healthy lifestyles? The authors present a reconstructed perspective of "healthy lifestyle". Evidence for the effectiveness of lifestyle interventions, and promising approaches to cultivate healthy lifestyles are presented. It is posited that the difficulty in changing the lifestyles of Canadians to improve their health may be largely due to the way that lifestyle has been defined and promoted, and the ways that people, especially those of lower socio-economic status, are enabled to live healthy lifestyles. The approach to health presented in this paper emphasizes the interdependence between individuals and their community or communities. The bulk of research and intervention has focused on the lifestyles of individuals. Therefore we devote time in this paper to explicate the social and community aspects of healthy lifestyles. At the end of each section, we include a Key Points section to summarize the major points examined.

This paper is based on the following perspectives:

1. People's lifestyles are significant contributors to their physical health, psycho-social (emotional, psychological, spiritual) health and well-being.

2. Lifestyle, particularly when related to "risk" behaviours such as smoking and physical inactivity, is typically conceptualized as a function of individual choice.

3. The concept of "lifestyle" has considerable value in the analysis of the health of Canadians, but not as it is currently conceptualized.

4. Expanding lifestyle beyond an individualistic notion is a key to fostering healthy people and healthy communities.

5. Understanding the relationship between individuals and their social context will lead to the development of more effective methods to improve the health of Canadians.

6. Opportunities to engage in and change the social context foster health. Engagement at these various levels means that the culture does not simply act on the individual to influence his or her lifestyle. Individuals and groups of individuals must act to appraise and change aspects of the social context to enable healthy lifestyles (theirs and those of the people around them). Macro level policies and practices have a substantial impact on the lifestyle of individuals, their relationship to their communities, and the capacity of communities to foster the health of individuals.

7. Partners in health promotion and population health have an important role to play in developing and supporting a new "community-oriented" conceptualization of lifestyle, marketing the idea, and providing a supportive environment to enable it to happen.