Theresa Marteau, University of Cambridge, Storbritannien<\/p>\n\n\n\n
Mange af os k\u00e6mper med at spise sundere, drikke mindre alkohol, holde op med at ryge eller g\u00e5 i stedet for at k\u00f8re. Det g\u00e6lder, selv n\u00e5r vi ved, at disse \u00e6ndringer vil gavne b\u00e5de vores helbred og planeten. Det g\u00e6lder ogs\u00e5 psykologer og adf\u00e6rdsforskere s\u00e5vel som de mennesker, vi fors\u00f8ger at hj\u00e6lpe.<\/p>\n\n\n\n
Denne kamp er ikke et tegn p\u00e5 manglende viljestyrke. Problemet er, at vi konsekvent undervurderer, hvor meget vores daglige omgivelser former vores adf\u00e6rd, og overvurderer styrken af vores v\u00e6rdier og intentioner.<\/p>\n\n\n\n
Hvorfor viden ikke er nok<\/strong><\/p>\n\n\n\n Overvej personlige sundhedsforudsigelser. Man kunne tro, at hvis man fort\u00e6ller nogen deres pr\u00e6cise risiko for at udvikle type 2-diabetes eller hjertesygdom, s\u00e5 vil det motivere til forandring. Evidensen viser noget andet. Fem systematiske litteraturgennemgang, som inkluderer snesevis af randomiserede kontrollerede fors\u00f8g, viser, at det at give mennesker personlige risikovurderinger \u2013 herunder genetiske risikoscorer<\/a> \u2013 har lille eller ingen effekt p\u00e5 deres adf\u00e6rd. Niveauer af fysisk aktivitet, rygning, alkoholforbrug og usund kost forbliver u\u00e6ndrede.<\/p>\n\n\n\n Tilsvarende har klimaforskere<\/a> detaljeret viden om klimaforandringer, men flyver ofte lige s\u00e5 meget som andre akademikere. Viden alene f\u00f8rer sj\u00e6ldent til vedvarende adf\u00e6rds\u00e6ndringer<\/a>.<\/p>\n\n\n\n Det handler om omgivelserne<\/strong><\/p>\n\n\n\n Dobbeltprocesmodeller<\/a> (\u2018Dual Process Models\u2019) fra adf\u00e6rdsvidenskaben hj\u00e6lper med at forklare dette. Vores adf\u00e6rd reguleres af to samspillende systemer. Det ene er langsomt, refleksivt og m\u00e5lrettet. Vi bruger det til at l\u00e6se, l\u00e6re nye f\u00e6rdigheder og modst\u00e5 fristelser. Det andet er hurtigt, automatisk og styret af signaler \u2013 n\u00e5r vi ser kage, tager vi et stykke. N\u00e5r vores begr\u00e6nsede refleksive kapacitet er fuldt optaget, reagerer vores automatiske system direkte p\u00e5 milj\u00f8m\u00e6ssige signaler<\/a>. Derfor er det ofte mere effektivt at \u00e6ndre signalerne omkring os end at fors\u00f8ge at \u00e6ndre, hvad der foreg\u00e5r i vores hoveder.<\/p>\n\n\n\n De mest kraftfulde milj\u00f8m\u00e6ssige signaler falder under de tre A\u2019er: overkommelighed (affordability), tilg\u00e6ngelighed (availability) og appel (appeal).<\/p>\n\n\n\n Overkommelighed: Pris\u00e6ndringer \u00e6ndrer adf\u00e6rd<\/strong><\/p>\n\n\n\n At h\u00e6ve tobakspriser er den mest effektive enkeltst\u00e5ende politik til at reducere rygning. En prisstigning p\u00e5 10 % reducerer tobaksforbrug<\/a> med omkring 4 %. Sodavandsafgifter<\/a> reducerer forbruget af sukkerholdige drikke. Forbruget af frugt og gr\u00f8nt stiger med subsidier<\/a>, der s\u00e6nker deres pris.<\/p>\n\n\n\n Tilg\u00e6ngelighed: Det, der er let at f\u00e5 fat i, bliver valgt<\/strong><\/p>\n\n\n\n I et studie med 20.000 ansatte p\u00e5 tv\u00e6rs af 19 arbejdspladscafeterier \u00f8gede mit forskerteam andelen af frokoster med f\u00e6rre kalorier og reducerede portionsst\u00f8rrelserne af mere kalorierige m\u00e5ltider. Resultatet? Medarbejderne k\u00f8bte 11,5 % f\u00e6rre kalorier<\/a>, efterh\u00e5nden som sundere muligheder blev lettere at v\u00e6lge.<\/p>\n\n\n\n Appel: Reklame virker<\/strong><\/p>\n\n\n\n At stoppe reklamer og sponsorater fra tobaks<\/a>-, alkohol<\/a>– og usund f\u00f8devareindustri<\/a> reducerer produkternes appel og k\u00f8b. Lignende effekter forventes for fossile br\u00e6ndsler<\/a>. Tydelige advarselsm\u00e6rker og fjernelse af branding fra produkter reducerer ogs\u00e5 deres appel. M\u00e6rkater p\u00e5 alkohol i Yukon, Canada, som tydeligt advarede om kr\u00e6ftrisiko ved alkohol, reducerede alkoholsalget<\/a> med omkring 6 %. Standardiseret indpakning af tobak g\u00f8r advarselsm\u00e6rker mere synlige<\/a>.<\/p>\n\n\n\n Hvorfor regulering er vigtig<\/strong><\/p>\n\n\n\n De fleste indsatser, der \u00e6ndrer signalerne i vores daglige omgivelser for at \u00e6ndre adf\u00e6rd, kr\u00e6ver regulering<\/a>, fordi de kolliderer med kommercielle interesser. Fire industrier \u2013 tobak, alkohol, usunde f\u00f8devarer og fossile br\u00e6ndsler \u2013 producerer varer, der for\u00e5rsager mindst \u00e9n ud af fire d\u00f8dsfald globalt<\/a> hvert \u00e5r, og st\u00f8rstedelen af drivhusgasudledningerne<\/a>, som opvarmer klimaet.<\/p>\n\n\n\n Alligevel er informationskampagner og frivillig selvregulering i industrien fortsat de foretrukne tilgange. Disse industrier fremmer aktivt denne pr\u00e6ference gennem lobbyisme, finansiering af forskning der s\u00e5r tvivl om regulering, og ved at fremstille statslig indgriben som en begr\u00e6nsning af friheden.<\/p>\n\n\n\n Hvad der skal \u00e6ndres<\/strong><\/p>\n\n\n\n Vi er n\u00f8dt til at beskytte evidens og politiske beslutningsprocesser mod virksomheders indflydelse. Tobakskontrol giver en model. Lande, der har vedtaget artikel 5.3 i den internationale traktat<\/a> om tobakskontrol, har beskyttet politiske processer mod industrip\u00e5virkning, implementeret flere evidensbaserede politikker og har lavere rygerater. Vi b\u00f8r udvide denne beskyttelse til at omfatte alle virksomheder, der producerer produkter, som skader vores sundhed og \u00f8del\u00e6gger vores planet. Borgerforsamlinger<\/a> og andre former for deliberativt demokrati, hvor borgere arbejder sammen med lokale eller nationale regeringer, viser ogs\u00e5 stort potentiale \u2013 b\u00e5de for at \u00f8ge borgernes indflydelse p\u00e5 politiske beslutninger og for at styrke evidensens rolle.<\/p>\n\n\n\n Praktiske anbefalinger<\/strong><\/p>\n\n\n\n For sundhedsprofessionelle<\/strong><\/p>\n\n\n\n 1. Start med omgivelserne, ikke med undervisning.<\/p>\n\n\n\n N\u00e5r du arbejder med klienter eller patienter, s\u00e5 identific\u00e9r de milj\u00f8m\u00e6ssige signaler, der udl\u00f8ser u\u00f8nsket adf\u00e6rd. I stedet for udelukkende at fokusere p\u00e5 motivation eller viden, s\u00e5 hj\u00e6lp mennesker med at redesigne deres n\u00e6rmeste omgivelser. For eksempel:<\/p>\n\n\n\n hold frugt synligt og forarbejdede snacks ude af syne; placer cykler i gangarealer i stedet for i k\u00e6lderen; brug mindre tallerkener og glas.<\/p>\n\n\n\n 2. Arbejd for \u00e6ndringer p\u00e5 arbejdspladsen.<\/p>\n\n\n\n Samarbejd med din institution om at \u00f8ge tilg\u00e6ngeligheden og reducere prisen p\u00e5 sundere muligheder i kantiner. Enkle \u00e6ndringer, som at g\u00f8re plantebaserede m\u00e5ltider til standardvalg med mulighed for nemt fravalg, kan flytte adf\u00e6rd markant.<\/p>\n\n\n\n For folkesundhedsgrupper<\/strong><\/p>\n\n\n\n 3. G\u00f8r det usynlige synligt.<\/p>\n\n\n\n Brug jeres platforme til at kommunikere, hvordan omgivelser former adf\u00e6rd. Udfordr den dominerende fort\u00e6lling om, at adf\u00e6rds\u00e6ndringer prim\u00e6rt handler om individuel viljestyrke eller viden. Evidensen viser, at det i h\u00f8j grad handler om at \u00e6ndre kontekster \u2013 ikke kun tankes\u00e6t.<\/p>\n\n\n\n 4. Inddrag beslutningstagere.<\/p>\n\n\n\n Identific\u00e9r huller mellem evidens og politik, b\u00e5de lokalt og nationalt. Skriv til beslutningstagere med konkrete anbefalinger baseret p\u00e5 evidens. Mange er modtagelige for ekspertinput, is\u00e6r n\u00e5r det indeholder praktiske l\u00f8sninger. Mit brev til en britisk sundhedsminister f\u00f8rte for eksempel til en evidenssyntese om at \u00e6ndre adf\u00e6rd for at \u00f8ge sund levetid<\/a>.<\/p>\n\n\n\n 5. Opbyg koalitioner for regulering.<\/p>\n\n\n\n Samarbejd med organisationer, der arbejder for evidensbaserede politikker om tobak, alkohol, f\u00f8devarer og transport. F\u00e6lles fortalervirksomhed er afg\u00f8rende for at modvirke industriens indflydelse. Se efter muligheder for at levere evidensopsummeringer, der st\u00f8tter st\u00e6rkere regulering \u2013 p\u00e5 samme m\u00e5de som tobaksregulering lykkedes gennem koordineret ekspertengagement med beslutningstagere.<\/p>\n","protected":false},"excerpt":{"rendered":" By Theresa Marteau, University of Cambridge, UK Many of us struggle to eat more healthily, drink less alcohol, quit smoking, or walk instead of driving. This is true even when we know these changes would benefit our health and the […]<\/p>\n","protected":false},"author":9,"featured_media":4797,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"off","_et_pb_old_content":"By Theresa Marteau, University of Cambridge, UK<\/strong>\n\nMany of us struggle to eat more healthily, drink less alcohol, quit smoking, or walk instead of driving. This is true even when we know these changes would benefit our health and the planet. It applies to psychologists and behavioural scientists as well as the people we're trying to help.\n\n\n\nThis struggle isn't a failure of willpower. The problem is we consistently underestimate how much our everyday environments shape our behaviour, and overestimate the power of our values and intentions.\n\nWhy knowing isn't enough<\/strong>\n\nConsider personalised health predictions. Surely telling someone their exact risk of developing type 2 diabetes or heart disease would motivate change? The evidence says otherwise. Five systematic reviews including dozens of randomised controlled trials show that giving people personalised risk estimates\u2014including genetic risk scores<\/a>\u2014has little or no impact on their behaviour. Rates of physical activity, smoking, alcohol consumption, and unhealthy eating remain unchanged.\n\nSimilarly, climate scientists<\/a> possess detailed knowledge about climate change yet often fly as much as other academics. Knowledge alone rarely drives sustained behaviour change.<\/a>\n\nIt\u2019s the environment<\/strong>\n\nDual Process Models<\/a> from behavioural science help explain this. Our behaviour is regulated by two interacting systems. One is slow, reflective, and goal-directed. We use it to read, learn new skills, and resist temptation. The other is fast, automatic, and cue-driven\u2014when we see cake, we take it. When our limited reflective capacity is fully occupied, our automatic system responds directly to environmental cues<\/a>. This is why changing the cues around us is more powerful than trying to change what's in our heads.\n\nThe most powerful environmental cues fall under the 3 As: Affordability, Availability, and Appeal.\n\nAffordability: Price changes behaviour<\/strong>\n\nIncreasing tobacco prices is the single most effective policy to reduce smoking. A 10% price increase reduces tobacco use<\/a> by around 4 %. Soda taxes<\/a> reduce consumption of sugary drinks. Fruit and vegetable consumption increases with subsidies<\/a> to lower their price.\n\nAvailability: What's accessible gets chosen<\/strong>\n\nIn a study with 20,000 employees across 19 workplace cafeterias, my research team increased the proportion of lower-calorie lunches offered and reduced portion sizes of higher-calorie meals. The result? Employees purchased 11.5% fewer calories<\/a> as healthier options became easier to choose.\n\nAppeal: Advertising works<\/strong>\n\nStopping advertising and sponsorships by the tobacco<\/a>, alcohol<\/a>, unhealthy food<\/a> industries reduces the appeal and purchasing of their products. Similar effects are expected for fossil fuel<\/a> products. Adding clear warning labels and removing branding from products also reduces their appeal. Labels on alcohol in Yukon, Canada, clearly warning of cancer from drinking, reduced alcohol sales<\/a> by around 6 %. Plain packaging of tobacco renders warning labels more visible<\/a>.\n\nWhy regulation matters<\/strong>\n\nMost interventions that alter cues in our everyday environments to change behaviour require regulation<\/a> because they conflict with commercial interests. Four industries\u2014tobacco, alcohol, unhealthy food, and fossil fuels\u2014generate products that cause at least one in four deaths globally<\/a> each year, and the majority of greenhouse gas emissions<\/a> warming the climate.\n\nYet information campaigns and voluntary industry self-regulation remain the favoured approaches. These industries actively promote this preference through lobbying, funding research that questions regulation, and framing government intervention as restricting freedom.\n\nWhat needs to change<\/strong>\n\nWe need to shield evidence and policymaking from corporate interference. Tobacco control provides a model. Countries that have adopted Article 5.3 from the international treaty<\/a> on tobacco control protected policymaking from industry interference, implemented more evidence-based policies, and have the lower rates of smoking. We need to extend this protection to cover all corporations generating products that ruin our health and wreck our planet. Citizen Assemblies<\/a> and other forms of deliberative democracy in which citizens work collaboratively with our local or national governments also show much promise both in increasing citizens influence on policymaking and the influence of evidence.\n\nPractical Recommendations<\/strong>\n\nFor healthcare practitioners<\/strong>\n\n \t
\n \t