Motivation, Health, and the Type and Timing of Interventions

So I wanted to write a post about motivation.  After all, it occurred to me when I was sick earlier this year, that health, as so many other endeavours in life, requires motivation.  You have to want to be healthy, just like you have to want to be a good person, or a good athlete, or a good writer in order to actually become one.  I was inspired by reading a business blog where I saw this list: 9 things that successful people do (and that you should do too).  And I was shocked because it seems easier to find a “how to” guide for gaining success in ones careers than it is to find a guide to being successful in ones health. (Seriously, how about applying these 9 rules to any health goal? Eating right, exercising?)

Don’t get me wrong.  There is, in fact, plenty of guidance out there.  There is a new “food plate” (goodbye, food pyramid!) telling you what to eat, there are recommendations to get 30 minutes of cardiovascular exercise in 5 times per week (anybody else think that’s funny?), and if I go visit my doctor or dentist I usually get a bunch more good advice for what I should be doing.

But it doesn’t come with a “how to” guide.  And I want one, please.

Because I was thinking that if I, who have no dependents and a lot of freedom, have trouble eating and exercising the way I should and may get submerged by stress more often than my research recommends I do… then my guess is that people with lifelong bad habits, kids, mortgages, and careers are going to have a pretty rough time too.  

So my original thought was: “Why don’t I get more motivational psychology when I go visit my doctor?”

But as I was pondering the feasibility of this (as well as searching for any evidence that it would help), I realised two things:

1)      Even if motivational interventions worked very well for health-related issues (and it seems like they might work more at the “OK” level), they would probably have an effect in disease prevention, rather than in the people already suffering from chronic pain or disease.

2)      Humans are social creatures with certain hard-wired preferences (for example, for fatty foods), and the behaviour of those around us influences us profoundly.  I.e., asking an individual to change their habits alone without taking into account the society they operate in is completely unrealistic. (See this article by Christakis & Fowler, 2007 if you have not. Because it's awesome.)

If we want to get serious about the prevention and treatment of the biggest epidemics in our society at this time (read: heart disease, cancer, depression, obesity), it has to happen at a community or even at a policy level.

Asking people to go it alone flies in the face of everything we know about social psychology and how people operate.  People are willing to lie about perfectly concrete realities in order to fit in with a group of people they barely know (Asch, 1951)… what makes us think they are willing to change bad habits (e.g., exercising instead of watching American Idol, quitting smoking, etc.) if their friends or families do?

Individual motivation, though it seems to underlie many a success story, will never be the whole answer (Gladwell, 2008).  Motivation interventions will probably be successful if they are aimed at a group of people who are in a situation where they can respond to them.  And maybe that’s why you’re more likely to hear a motivational psychologist comment on success in the corporate world than on success fighting coronary artery disease. 

We need to find a way to get communities to be healthy, not just individuals.  We need to think big in terms of “herd immunity” to chronic disease.  We need to influence policy leaders who can make real change come into our environments in terms of what we eat and help improve our communities (first of all, by making sure we have communities!) by better city planning and promoting health and wellness, stress reduction and physical activity.

Public health approaches might be the most direct and effective solution to the current epidemic of chronic “lifestyle” diseases.  Individual responsibility is important, yes.  But integrating healthful eating and physical activity into our daily lives is a change that is going to happen on a community level.  Ignoring the power of the infrastructure we live in to shape our lives is naïve.  And, I might add, unscientific.