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

Summary and Conclusions

This paper has examined the notion of "healthy lifestyle" from four perspectives: what it means and it's value in improving health; the factors that influence lifestyle choices; the approaches that have been used to enhance health behaviors; and new approaches that include the relationship between the individual and the community as a key aspect of a healthy lifestyle. In each section of the paper, we have provided a list of key points.

As stated earlier in the paper, some health issues are addressed with relative ease (e.g. using seatbelts to protect drivers and passengers). However, many other health concerns such as exercise, nutrition, smoking, and alcoholism are integrally linked to culture and to SES (Kawachi et al., 1996; Labonte, 1998; Lupton, 1994; Marmot et al, 1997; Stewart et al., 1996), and are much more difficult to address. Evidence shows that many of these health-related personal and social factors are subject to modification, but only through comprehensive, inter-sectoral, long term strategies that employ a variety of health promotion and disease prevention approaches (FPT Advisory Committee on Population Health, 1994; Frohlich & Potvin, 1999; Hobfoll, 1998; Hyndman, 1998; Lomas, 1998).

Fostering healthy lifestyles is about modifying the content of and relationship between lifestyles, life skills, and life circumstances. Therefore, we must approach the conceptualization of "healthy lifestyle" and strategies to promote it very thoughtfully. More complex approaches will require more time to conceptualize, implement, and evaluate.

A Determinants Approach to "Healthy Lifestyle"

"Lifestyle" is an adaptation to one's social environment. Unless lifestyle is constructed (as a category of intervention) in concert with the way that lifestyle is experienced by target group(s), interventions are unlikely to succeed. The strategies for action set out in the Ottawa Charter are relevant to interventions aimed at the interdependence of individuals and communities, with most emphasis placed on strengthening communities, environments, and public policy arenas.

By addressing the determinants of health in a systematic manner, it has been demonstrated that individuals can live longer and healthier lives. To achieve these goals, individuals need personal knowledge and skills plus a facilitative social environment where these skills can be put to effective use. This latter point recognizes the need to institute measures that will address health and healthy lifestyles from a "systems" or "community" perspective, if health gains are to be achieved and sustained.

What Needs to be Done?

In order to effectively use a "reconstructed" concept of healthy lifestyle in the formulation of health policies and programs, some changes are required in the following:

1. reframing "healthy lifestyle";

2. the approaches used to foster healthy lifestyles;

3. research; and

4. policy.

1. Reframing "Healthy Lifestyle"

A healthy lifestyle is a resource for quality of life and coping. Health is an investment whose benefits grow over time. By learning the art of being healthy, building resources for making healthy decisions, and building social capacity, a healthy lifestyle becomes a long term investment.

• Develop health promotion interventions considering the social context, with "helping others to be their best" in mind.

• Do not increase the gradient between those who are healthy and those who are unhealthy.

• Promote the creation of physical and social environments that support and strengthen healthy lifestyles.

• Provide "rescue" services for people who are at high risk for unhealthy behavior.

• Change the role of the community vis a vis health. Healthy communities provide a legacy of health for our children.

• Consider age and life stage, short and long term consequences, and the role of social relationships in health.

• The best investments toward healthy lifestyles are to improve basic living conditions and to strengthen communities.

• Use slogans in social marketing campaigns that promote "individual in the context of community" orientations, such as:

  My health is up to me - but not me alone. Health - We're in it together. Let's create a supportive environment for health. Take a risk - don't follow an unhealthy trend.

2.1 General Approaches to Foster Healthy Lifestyles

• Develop support interventions that reward positive health behaviors (acknowledgment, money, forums to exchange ideas, documents that share strategies, awards for people and communities, health "heroes", model communities to visit.

• Link the initiatives governments are already undertaking to the notions of lifestyle (e.g., CAP-C).

• Do not invest in social marketing with the traditional lifestyle messages, as this tends to increase the social gradient. Instead, distribute information about a new model of healthy living so that attitudes shift to recognize that health is individual, environmental, and social.

• Portray a "culture" that supports healthy people in healthy communities.

2.2 Community Approaches to Foster Healthy Lifestyles

• Support quality projects that strengthen community-level strategies to foster health. Provide opportunities to profile and share the findings of such projects (e.g., healthy communities, healthy schools, healthy workplaces).

• Support community initiatives that modify the relationship between individuals and environment (using a socio-ecological approach).

• Provide insight into how to increase the level of participation of people in the health of their community and its members, and how communities can mobilize internal and external human resources (e.g., from universities) to work together collaboratively to foster healthy living. Support the creation of community infrastructure such as community-based organizations, citizen's groups, tenants groups, community centres, community events.

• Support community outreach programs and other strategies that reduce isolation of individuals and social groups. Support local recreational programs that include persons at high risk for social isolation: youth, persons with disabilities, and the elderly.

• Support community meeting and recreation places that permit people to coalesce around issues and actions that foster health.

• Support dialogue to clarify roles for supporting healthy lifestyles in communities.

• Facilitate action at the community level by encouraging civic participation and contributing resources to community level initiatives that promote thinking about the connection between individual health and community health.

• Discuss current health problems in the context of community rather than blaming the victim.

• Create a fund that supports communities to development healthy lifestyles across Canada.

• Support skills training on technologies of participation (how to be inclusive, group process, group decision-making, conflict resolution, team-building, leadership that builds participation).

3. Research

• Evaluate and synthesize lifestyle and health promotion strategies that work.

• Commission a systematic review of the effectiveness of lifestyle/health promotion interventions.

• Create new indicators and measures (contributions to others, community capacity, health culture of communities, individuals who change) that support the community as a unit of analysis for health and social aspects of lifestyle.

4. Public Policy to Support Healthy Lifestyles

• Apply a "healthy lifestyles lens" to policies that affect the health and well-being of citizens.

• Ensure that policies decrease the challenges of daily living, particularly for the most vulnerable populations (e.g., persons with disabilities, children, people on welfare, single parents, new immigrants, seniors).

• Involve policy-makers "on the ground" in community-level interventions to broaden mutual understanding about healthy lifestyles.

The Last Word

As indicated at the beginning of this paper, it takes time for ideas to evolve, as well as evidence to be discovered, synthesized, and examined for its relevance to policy and action. The concepts and approaches suggested in this paper are in their "incubation" stages. The issue of healthy lifestyles and how we approach this topic are critical. As health budgets are squeezed and increased pressure is placed on individuals to live healthier lives, it is incumbent upon policy makers to thoughtfully consider their leadership on this issue.