The lazy language of ‘lifestyles’ – let’s rid this from our talk about prevention

April 17, 2019 in ADPH Updates, President's Blog by Teresa Grandi

By Jeanelle de Gruchy, President ADPH

I’m writing this blog as I drink my flat white following my yoga class where the yoga teacher was wearing a fab ‘Carbs and cuddles’ sweatshirt; this is the life I think, this is my choice, this is my lifestyle.

I go out to my car and head for the motorway, annoyed that I will now have to sit for 40 minutes in traffic to my new office up north. Not really my choice I think, not really the lifestyle I want. Down south, I didn’t have to do that, I lived closer to work, and public transport was [subsidised] better. In one place I walk more and in another sit in a car in traffic more – same me, same motivation, different place, different behaviour. Environment and the choice landscape matters to how physically active I am. ‘Lifestyle’ doesn’t really explain it. So why do we keep using this word as if it explains everything about our health?

A number of years ago I read a blog that has stuck with me ever since – in 2015, Paul Lincoln wrote ‘Lifestyle: a plea to abandon this word in public health’ https://ukpublichealthnetwork.org.uk/lifestyle-a-plea-to-abandon-the-use-of-this-word-in-public-health/.  

In this strongly worded piece, Paul targeted the public health communities’ widespread and unquestioning use of the term ‘lifestyle’ and called for its use to be completely abandoned. His main argument was that its use frames public health at an individual level – ‘effectively blaming individuals for making irrational decisions that are detrimental to their health’.

The lazy language of lifestyle, and the lazy thinking behind it perpetuates a disproportionate focus on the individual over the range of behavioural, environmental and social determinants of health – and on individualistic solutions aimed at the individual just making different choices and changing their ‘unhealthy lifestyle’.

Apart from being ineffective, this framing of the problem, he argues, suits certain ideological viewpoints that tend to frame any counter view as nanny state-ism, and ‘helps industries that produce health-harming goods escape responsibility’. It also leads too easily to blaming those who don’t change their ‘lifestyles’ and are therefore responsible for their own early illness and death.

Paul asserted that continued use of ‘lifestyles’ was in fact ‘a harmful and unethical determinant of bad public health practice’, and should become anachronistic, especially given claims of a new narrative on prevention which demands a focus on the social determinants of health.

Unfortunately, ‘lifestyle’ has not become an anachronism. Unfortunately – and I would argue unacceptably – it’s still all too normal for public health professionals to uncritically use the term ‘lifestyles’. And despite the evidence, we continue to situate solutions in individuals and interventions to change their ‘lifestyle choices’.

The current use of ‘lifestyle’ has its origins in business marketing, a word capturing how to create desire and promote consumption. This isn’t done individually, but by using very sophisticated techniques targeting particular segments of society – groups of people, not individuals – selling cigarettes, alcohol, the best odds, Easter Eggs and fizzy drinks to make the world sing in perfect harmony. It’s a commercial determinant of health – and Paul Lincoln suggested the word ‘deathstyle’ would be more apt, given the way many of these commodities contribute to early death.

‘Lifestyle’ does two things – it puts emphasis on the individual, framing health-harming behaviour as individual choice so that secondly, it takes the focus away from the socio-economic determinants of health and from the health inequalities experienced by groups of people.

The Health Foundation and Frameworks Institute has been leading work to reframe the conversation on the social determinants of health – and I strongly recommend their Briefing to you (https://www.health.org.uk/thinking-differently-about-health ).

How we choose to frame things is critical, as the language we use, how we explain things and what we don’t say influences how people make sense of and engage with issues. They note that, ‘despite extensive evidence of the impact of social determinants on people’s health, public discourse and policy action is limited in acknowledging the role that societal factors such as housing, education, welfare and work play in shaping people’s long-term health’. It’s the differences in these factors that drive the profound inequalities in health outcomes.

Their research shows that the dominant way people conceptualise health is through models of individual choice and health care – and the solution is ‘raising awareness’ so people make different choices (and if they don’t, well then…) and the NHS. It’s not surprising therefore that the focus for policy makers is on individual-focused interventions and on the NHS.

They set out some preliminary steps to build support for the policies and programmes that will be much more effective in improving health and reducing health inequalities. The first one is: ‘Beware of gesturing to the importance of individual choice or responsibility’. I think we need to stop prioritising talk about ‘lifestyles’. 

Of course, there is another use of the term – the Urban Dictionary reminds me that many use the term for sex and sexuality – and that it wasn’t that long ago that a dominant discourse was about some people adopting a ‘gay lifestyle’ to denote active choice and how that, so easily, led to victim-blaming. ‘Lifestyle’ was problematic then, it remains problematic now. What I like about this reminder of usage is that it shows the power of language – and how it can work insidiously and ideologically to maintain hegemonic power, the power of the ‘norm’, in this case of the heterosexual community. What I also like about this reminder is it shows how this power was challenged by citizens working collectively, using the language of human rights to deconstruct this dominant discourse and impacting positively on this inequality. Isn’t it time for us to do the same with the use of ‘lifestyles’ in health?

The new enthusiasm for prevention and population health are important opportunities for us as public health professionals to get our own thinking and language in order on what matters.

While I know a lot of us don’t like the emphasis on the individual, we do need to think through our role in continuing to privilege this problematic paradigm. We need to reframe our own narrative – which too often favours individualistic approaches – in order to more effectively influence priorities and plans. If we’re serious about preventing ill-health, reducing inequalities and improving health and wellbeing, we do need to focus on those things that will actually make a sustainable difference.

So the next time we cycle to work, nip out for sushi at lunch, sip on our cappuccinos and plan our pensions, let’s think through how we’re able to do this, and let’s talk about how we talk about those things that determine whether our lives are healthy or not.