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

April 17, 2019 in ADPH Updates, President's Blog

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. 

Annual DPH Workshop and AGM 2019

February 21, 2019 in Events, Headline Events, Masterclasses and workshops

16th May 2019

St Brides Foundation, Central London

The Annual DPH Workshop provided some engaging discussions on key policy issues as well as challenges and opportunities within the wider PH system. The ADPH Annual General Meeting was held on the same day. 

The programme included:

  • Presentations by Niven Rennie, Director of the Scottish Violence Reduction Unit and Lib Peck, Director of the London Violence Reduction Unit followed by panel discussions focusing on the PH approach to violence
  • Table discussions – on specific PH policy topics as well as the wider PH system
  • Annual Report Competition results – overview of submissions and announcement of this year’s winner
  • Sharing practice on measuring impact – examples and presentations from Networks
  • Networking opportunities

Click here to view the evaluations’ summary. Further material, including speaker presentations, is also available to view on eForums

Please contact Teresa Grandi for any queries.

Immersive Workshop: Integrated Care Systems

February 20, 2019 in Events, Masterclasses and workshops

Monday 29th April, St Brides Foundation, central London

The Immersive Workshop on Integrated Care Systems (ICSs) offered delegates a chance to discuss key issues around ICSs and Population Health Management (PHM) and map common areas and challenges. The day comprised presentations by external speakers and DsPH/CsPH with ICSs experience as well as opportunities to network and discuss key issues around the topic. The material is available to download below.

Presentation by Alex Baylis (Acting Director of Policy, The King’s Fund)

589 KBContextualising ICSs: perspective from the King’s Fund

Presentation by Bob Ricketts (Director of System Support, NHS England)

1 MBContextualising ICSs: perspectives from NHS England

Presentation by Helen Atkinson (Executive Director of Public Health and Wider Determinants of Health, Surrey County Council and ADPH Honorary Secretary- Infrastructure)

2 MBThe role of DsPH within the context of ICSs

Presentation by Nicky Cleave (Assistant Director of Public Health, Dorset & part-time GP)

1 MBICSs and PHM in context: local perspectives

Contact Teresa for any queries.

Immersive Workshop: Expanded Portfolios

February 19, 2019 in ADPH Updates, Events, Masterclasses and workshops

Tuesday 5th March 2019, St Brides Foundation

The workshop provided an opportunity to network with and learn from other DsPH with expanded portfolios that have taken on a wide range of responsibilities, from environmental health to road safety; leisure services to licensing.

Masterclass: Local Government Law and Practice

February 15, 2019 in Events, Masterclasses and workshops

Local Government Law and Practice: The Survival Guide for Directors of Public Health
Wednesday 19th June
Fleet Place House, 2 Fleet Place, London, EC4M 7RF

This workshop will be delivered by Bevan Brittan LLP, and it will cover key legal issues in local government including procurement, consultation and general powers, the powers and duties of elected members and officers.

Why?

To survive and be effective at senior level in local government you need to understand some key legal issues as they work in this sector, including procurement, consultation and general powers, the powers and duties of elected members and officers. This seminar will equip you with that essential knowledge. Feedback from previous sessions is this knowledge is valuable for Directors, Consultants and Assistant Directors in Public Health.

What?

A day where you will work with two very experienced senior lawyers: a partner of a major law firm with extensive local government experience and a practising long experienced council lawyer. Interactive sessions, with a detailed resource pack and ample time for your questions and issues are built into the day.

Space for this event is limited. DsPH should contact Teresa for further details and to register.

Training Session: Developing as a Mentor with ADPH

February 14, 2019 in Events, Masterclasses and workshops

Developing as a Mentor with ADPH

Training session for current and future Mentors

9th October, Bristol

This one-day training sessions is suitable for aspiring as well as established ADPH Mentors. It aims to help new Mentors understand how the ADPH mentoring scheme operates and to give more experienced Mentors, who are expected to attend a refresher session once a year, additional techniques and an opportunity to share experiences or discuss challenges with our expert mentoring trainer

The session will take place in Bristol on the 9th of October. New Mentors will be invited to arrive at 9:30 am and experienced Mentors at 11:00am. Full ADPH members, with over one and a half years of experience in a substantive DPH role, are eligible to attend.  

To sign-up to this training session, or if you are unable to attend but are still interested in becoming an ADPH Mentor, please contact Lucia.

ADPH/LGA Conference – Healthy weight, healthy future: making childhood obesity everybody’s business

February 14, 2019 in Events

Wednesday 17th July, central London

Organised jointly by the Local Government Association and the Association of Directors of Public Health, this conference will consider proposals outlined in the second chapter of the Government’s Childhood obesity plan for action and the position of local authorities as leaders of a whole systems approach to tackling childhood obesity.

Keynote speakers, expert panels and workshops will address questions such as:
  • How are councils helping schools to deliver the healthy weight agenda?
  • How to develop planning strategies to which prioritise local healthy food environments and protect green space?
  • Where should the soft drinks levy be spent to achieve maximum impact on children’s health?

This event will also be one of the first opportunities to hear from councils on the Trailblazer programme about the progress made so far, with a particular focus on the targeting inequalities.  

Click here to register, and contact Teresa for any queries.

Finance Masterclass: influencing budget decisions within local authorities

February 13, 2019 in Events, Masterclasses and workshops, Upcoming events

14th November 2019

Wellington House, London SE1 8UG

ADPH and PHE are pleased to announce this upcoming workshop, which will take place on the 14th of November at Wellington House. The objective of the day will be to broaden knowledge about finance issues and provide confidence to lead challenging conversations within this area. We are planning a contribution from a Local Authority CFO as well as technical input from PHE.

Further details will be circulated in due course, please contact Lucia to register your interest.

ADPH Annual Conference 2019

February 12, 2019 in Events, Headline Events, Upcoming events

22nd November 2019

Oval Kennington, south London

The 2019 ADPH Annual Conference will take place on the 22nd of November at the KIA Oval in south London. This year’s theme will be “Leading into the Future: the role of the Director of Public Health”.

This year’s theme will be “Leading into the Future: the role of the Director of Public Health”. The day will comprise a varied and dynamic programme of interactive sessions and keynotes from leaders in the field focusing on the built environment and sustainability, the DPH leadership role and a the Welsh Wellbeing of Future Generations Act. Delegates will also have ample opportunities to network with colleagues and share knowledge, insights and experiences on key public health issues such as ACEs, the public health approach to violence and Integrated Care Systems.

We are also planning to hold separate informal discussion sessions before the official start (around 9.15am) for new in post DsPH and for Associate members. Please let us know if you’d be interested in attending either one of these sessions and we’ll follow up with further details.

Click here to register

Our exhibitors this year will include:

Please contact Teresa for any queries.

System Leadership Skills and Practice Workshop: Public Narrative for Mobilising Action on Public Health

February 11, 2019 in Events, Masterclasses and workshops, Upcoming events

Friday 6th December

London Bridge Hive – 1 Melior Place, London SE1 3SZ

ADPH is pleased to announce this one-day participative workshop on System Leadership prepared and facilitated by Di Neale, Leadership Centre Enabler. The session will build on the learning of previous Systems Leadership workshops held in May 2018 but can also stand alone as a key leadership skill session for working effectively in complex systems.

Drawing on the art and science of Public Narrative, this workshop aims to help Directors of Public Health develop the skills needed to build compelling leadership narratives. Through a series of interactive sessions, delegates will focus on crafting stories that can motivate and mobilise others to join them in urgent action in order to further enable their work.

Attendees should expect plenty of interaction with colleagues and opportunities to discuss their priority areas.

Click here for more information about the venue and how to get there.

Further details about the day will be circulated closer to the date. Please contact Teresa to register your interest.