Imagine a man aged over 50 who is grossly overweight and eating a salt and vinegar saturated fried take-away fish supper, washed down with a sugary, high calorie soft drink. Having vociferously consumed the fish supper our man proceeds to open a can of strong lager and accompanies this by lighting up one of 60 cigarettes he consumes per day. Fruit and exercise, amongst others, are foreign to this man. In short he epitomises everything that defines the expression: ‘unhealthy lifestyle’.
Now take a lean man, also in his 50s. He exercises vigorously every day, cycles everywhere, eats at a minimum 5 portions of fruit and vegetables daily as part of a balanced diet, rarely drinks alcohol but when he does will never stray beyond the guidelines for daily consumption. In every respect this man adheres firmly to the precepts of a healthy lifestyle, almost, if you could envisage such a thing, a veritable pin-up for health promotion professionals. He is the antithesis of our obese, beer guzzling man.
Currently, all our health promotion material strongly exalts the second man and equally firmly disparages the first. Our first man is a lifestyle disaster and a walking time-bomb, very likely to die a premature death as a consequence. Yet, for all the health and other benefits likely to accrue by adopting the lifestyle of the second man relatively few people manage to do so.
These two men are at opposite ends of a spectrum. The issue, though is that the overwhelming majority of people are somewhere in the middle of this spectrum. They will try to keep their weight down, exercise occasionally, try to eat healthily and so on. But they will also take the occasional fry-up, have a booze-up every so often and laze about the house for long periods, without any adverse impact on their health and wellbeing.
At one time, and not so long ago, most health promotion advice and information reflected this reality. They enjoined people to try to pursue healthy living, but accepted that, being mere mortals, folk would occasionally break-out and have a fish supper and a good bevy. But as long as this wasn’t everyday, disaster wouldn’t befall.
Now the entire tenor of health messages is that you MUST effectively live your life like our hypothetical healthy man or face dire consequences. There is no middle ground, no brook with compromise; instead there is a stream of didactic stern injunctions to adhere to an ideal lifestyle which most people will not or don’t want to live up to. And because of that, most people end up switching off.
Health promotion messages in our contemporary society have morphed into propaganda, and as with all such messages in non-authoritarian societies, effectively turn their intended target audience off: People don’t like being shouted at and hence ignore or avoid them.
But health promotion messages are merely symptomatic of entire series of public service policy campaigns and promotions which seek to assert ideal ways of living and acting. From anti-discrimination to the promotion of equalities, from health and safety to the avoidance of causing ‘offence’, from risk minimisation to the endorsement of ‘positive messages’ to boost self-esteem we are being shouted at to adopt ideal ways and modes of behaviour.
What is missing from all this is the notion of messy compromises; the promotion of pragmatic common sense ways of living which allow people to lead their lives with an element of risk, experimentation and, yes, vicarious pleasure without going to excess. Messy compromise is the handmaiden of a pragmatic liberal politics that was the Hallmark of the British political system until the last thirty years. It avoided extreme positions while extolling the middle ground and worked effectively.
Didactic, uncompromising messages and campaigns, by contrast, easily accompany ideology. Ideology seeks to mould reality to a preconceived ideal form which inevitably ends up distorting it. Messy compromises do the opposite; they reflect the real situation on the ground and are consequently much more effective at promoting incremental social change.
This is no mere abstract argument. Possibly billions of pounds of public money has been spend on health improvement and public service initiatives, within the last twenty years, with no tangible benefits or improvements apparent. Concentrating on individual’s lifestyles and behaviour, which has been the focus of much public service campaigning while ignoring the wider socio-economic conditions people find themselves in, and which often gives rise to health and other social problems is flawed and easily perceived as such. Shouting at people is no substitute for effective social action. Meanwhile governments of both parties advocate radical changes in lifestyle and behaviour while offering few resources short of funding for ‘compliance’ and ‘monitoring’ posts to do so: A classic instance of trying to achieve macro solutions with micro resources, which gives the impression of sustained activity while achieving very little.
The looming draconian cutbacks in public spending might have one positive outcome. That is to persuade governments and others to eschew striving for ideal type lifestyles or grand total solutions, which are unattainable, and instead refocus on pragmatic, feasible solutions which don’t alienate people. This will necessarily involve messy compromises. And to realise that some of our current crop of health promotion and public service ideologues will have to loosen up or give way to more practically minded people.