Last week, I was walking with my mother, a self-proclaimed “worried well,” expressing my concerns with “health” being the reason for promoting “heath-related” behaviors. She reminded me that, for her, health and preventing disease are the greatest motives for her daily walks. Then I reminded her that she didn’t start regularly walking until she retired and had a lot more time to fit it fitness. She agreed. Therein is the problem.
If you are a clinician, CEO, heath game developer, health and wellness service provider, coach, or HR and wellness representative, these ideas are relevant for you.
In the midst of this health-care-cost tsunami with more treacherous waves approaching, the suggestion to stop promoting health might seem heretical. Yet, there are research-based reasons why “health” may be the wrong goal to promote if improved employee health, and the resulting productivity and cost savings benefits it brings, is the desired outcome. This post presents three primary reasons that targeting “health” as the reason, or “hook,” to promote lifestyle changes is inherently flawed and undermines the foundation for lasting motivation and behavior change.
Health promotion is an interesting intersection of medical and business goals. The general aim of health promotion is to foster “healthy” lifestyles among individuals as a means to reduce health care costs and improve health biomarkers and outcomes in businesses such as increased productivity and reduced absenteeism, which equate to an improved bottom line and more satisfied employees. Is this model a valid model?
The data showing that healthy individuals are cheaper than ill ones is up for debate. There is some evidence showing that organizational investments in health promotion yield savings but many question the quality of methods used in this research. In addition, the debate about whether extrinsic incentives undermine motivation or not is still underway.
Unfortunately, concluding that health promotion investments do not yield savings for organizations is based on making a decision about solutions, many if not most of which, have been primarily based on incorrect assumptions about human decision making and motivation. It is crucial to critically evaluate health promotion evaluation data, but it’s also important to deeply understand what is actually being evaluated. Imagine believing that cars can’t get high gas mileage because the dominant technology currently available and used in the auto industry doesn’t achieve this aim. Similar to the strides in technology for much better gas mileage, there have been huge strides in the science of human decision making. Yet these new insights, for the most part, have not been incorporated into the health promotion and wellness solutions available in the marketplace. Thus, the conclusion that promoting healthy lifestyles will not help organizations save money or get an ROI is based on research that embeds an important assumption: the health promotion solutions that have been researched are actually the best ones to foster the level of engagement and long-term participation necessary to achieve optimal productivity, health-related and cost savings outcomes. If these solutions have not been designed to leverage the unconscious, automatic goal pursuit, and other important aspects of daily decision making then our conclusions about the value of health promotion are based on outdated solutions, and not what might actually be feasible and possible to achieve.
But I digress.
Getting back to my main discussion, the assumption that promoting “health” as the reason or goal for doing self-care behaviors (e.g., eating more fruits and vegetables, moving more, stress reduction) is optimal for engaging individuals in their own health-related outcomes, especially fostering long-term behavioral sustainability has no basis in science – it’s simply convention.
Consider this, does it actually matter that lifestyles behaviors result in better health when it comes down to how to effectively market healthy choices? No. Health outcomes from lifestyle behaviors are irrelevant when we consider which outcomes will most effectively foster behavior and choices that people will stay motivated to prioritize in their busy daily lives.
Health Promoters Goals Are Irrelevant to What Is Most Motivating to People: Marketing 101 Revisited
The logic behind promoting healthy living is easy to understand: “If individuals make healthier choices, save is saved money, so let’s promote healthy living to people.” The problem is that logic doesn’t motivate. Emotions do.
Most successful business (think Apple) do not develop marketing campaigns that explicitly promote their goals (i.e., profit). Instead, they conduct thorough market research and use their target customers’ needs, wants and worries as the hooks in their marketing campaigns. Successful businesses brand products and services in strategic ways so that customers to try them and then continue to buy them. Business that are successful don’t want one time buyers, they want repeat customers.
For the most part, there has not been using a ‘repeat customer’ mentality when it comes to promoting lifestyle changes within organizations, health care or even society in general. Health promotion programs, services and marketing tend to feature desired ends that organizations hope for instead of the core values and goals their end users have. This is a strategic error that has expensive consequences for both organizations and employees.
In order to achieve better health, decreased health care costs, folks have to sustain the lifestyle behaviors that they start. Yet, as most readers know, the majority of people who try to change health-related behaviors do not maintain them – they drop out soon after starting.
Health is an Abstract Value and Not Compelling to Prioritize
University of Michigan research published Fall, 2011, showed that there is a gap between what people say they value and what they actually do. Working women reported highly valuing ‘good health’ and ‘aging well’ goals for exercising among their other top life goals. Yet goals related to improving daily quality of life through exercise trumped health-related goals when it came to their participation over one year.
What is going on? Modern society is a challenging place to promote healthy living! Today, people are continuously on the run, chauffeuring their kids places, getting to work on time, and tweeting their friends. In other words life is very very busy.
Most asked will say they want to be healthy and affirm that doing healthy things is important. We all want good health. But how essential is ‘health,’ really, compared to all of the top priorities and goals against which health-related behavior constantly competes for time?
The reality is that we not have time for important things. There is only time to fit in activities that are essential to our daily functioning and well-being.
Behavioral economics research shows that individuals have a present focus bias, meaning that they choose things that will reward them NOW over selecting benefits in the future. Larger distant rewards are not as motivating (e.g., “better health”) as smaller rewards that can be immediately experienced. Think “increased energy.”
Health is Not Actually the Goal. It’s a Proxy.
While a controversial thing to suggest: health isn’t really the goal we want. If you think about it, health is valuable only because it helps us live our daily lives.
Health is only the façade of the building. It’s what’s inside that we really really want. Health is valuable because without it we lack energy, and lack of vitality challenges our happiness, sense of well-being, and ability to achieve the daily roles and responsibilities that make life meaningful. Thus, health is really just a proxy for the experiences we desire and that make our life fun to live.
Research on goal striving and behavioral self-regulation (e.g., how we manage and negotiate behavior in our lives) clearly shows that if people are to continue to strive towards the goals they initiate then they need feedback that they are approximating their goals. Without evidence that they are making progress, they stop. Consider that, with “health” or “disease prevention” goals, heck even weight loss goals, people often don’t get regular or noticeable feedback when they are achieving these goals.
In contrast, when self-care goals target ‘feeling good’ or having ‘energy’ as the purpose, people get feedback, immediately, whenever they check in with themselves.
Simple Solution based on Science: Rebrand Health as Well-being.
Health and self-care behaviors have been, unfortunately, branded as ‘medicine’ and in very clinical and uninspiring ways. Instead of branding “health,” or self-care behaviors in the realm of medicine, for the purposes of engagement, motivation, and priorities, it would more strategic to rebrand them as direct vehicles to well-being. The reality is that that most of same behaviors that improve health (get more sleep, make better eating choices, move more) also lead to experiences that are compelling to experience in our daily lives, such as having more energy, a lifted mood, and less stress.
We just have to look toward Big Pharma to know that marketing outcomes like ‘happiness’ and ‘quality time with family’ from their behavior of interest, taking their drug, is a good idea. They’ve been doing it for years. Even Oprah understands the value of this idea. She changed the name of her magazine’s column from “health” to “feeling good” in late 2010. An article in the Wall Street Journal May 2012 reported that having “focus on quality of life helps medical providers see the big picture—and makes for healthier, happier patients.” This article primary talked about patients with a chronic illness. That those who have lost their ‘health’ and thus should be the most compelled to re-encounter it, are more motivated by feeling good than health suggests that health might be becoming a passé motivator of healthy living and disease management.
Translating Research into Real Life
Before 2006, I would have been one of the strongest advocates of “health” being a great reason to exercise and practice other self-care behaviors. In fact, I hypothesized that “health” as the primary reason to exercise would be optimal for motivation and participation in a longitudinal study. I couldn’t have been more wrong. Participants who exercised for “better health” had as poor motivational profiles and did as little exercise as the participants who exercised to lose weight. (We expected poor outcomes from those having weight loss goals for excise.)
I was left with the task of trying to understand and study other science that could help explain why ‘health’ wasn’t such a great reason to exercise (for women who worked full time anyway). Unclear findings are challenges that drive the investigator beyond their comfort zone of knowledge base and assumptions until they get glimmers of insights about counter findings.
Struggling to understand the fruits of unexpected findings is one of the most important ways science advances.
While there’s more to share about this, I’ll end the post here.
I leave you with this question: For you, what makes it to the top of your daily “to dos” – are they important things you value or essential things you can’t function well without?
I am open to all comments, including ones that challenge these ideas.
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