Theresa Marteau, University of Cambridge, UK<\/p>\n\n\n\n
Mnoh\u00ed z n\u00e1s maj\u00fa probl\u00e9my jes\u0165 zdrav\u0161ie, obmedzi\u0165 konzum\u00e1ciu alkoholu, presta\u0165 faj\u010di\u0165 alebo zvoli\u0165 ch\u00f4dzu namiesto jazdy autom. A to aj napriek tomu, \u017ee vieme, \u017ee by tieto zmeny prospeli n\u00e1\u0161mu zdraviu i \u017eivotn\u00e9mu prostrediu. T\u00fdka sa to nielen \u013eud\u00ed, ktor\u00fdm sa sna\u017e\u00edme pom\u00e1ha\u0165, ale aj n\u00e1s samotn\u00fdch – psychol\u00f3gov a behavior\u00e1lnych vedcov.<\/p>\n\n\n\n
Tento z\u00e1pas nie je zlyhan\u00edm v\u00f4le. Probl\u00e9m spo\u010d\u00edva sk\u00f4r v tom, \u017ee systematicky podce\u0148ujeme, nako\u013eko na\u0161e ka\u017edodenn\u00e9 prostredie formuje na\u0161e spr\u00e1vanie, a z\u00e1rove\u0148 prece\u0148ujeme silu vlastn\u00fdch hodn\u00f4t a z\u00e1merov.<\/p>\n\n\n\n
Pre\u010do samotn\u00e9 vedenie nesta\u010d\u00ed<\/strong><\/p>\n\n\n\n Zv\u00e1\u017eme napr\u00edklad personalizovan\u00e9 predikcie zdravotn\u00e9ho rizika. Mohlo by sa zda\u0165, \u017ee ozn\u00e1menie konkr\u00e9tnej pravdepodobnosti rozvoja diabetu 2. typu alebo kardiovaskul\u00e1rneho ochorenia bude silnou motiv\u00e1ciou k zmene. Empirick\u00e9 d\u00f4kazy v\u0161ak nazna\u010duj\u00fa opak. P\u00e4\u0165 systematick\u00fdch preh\u013eadov zah\u0155\u0148aj\u00facich desiatky randomizovan\u00fdch kontrolovan\u00fdch \u0161t\u00fadi\u00ed ukazuje, \u017ee poskytovanie personalizovan\u00fdch odhadov rizika \u2013 vr\u00e1tane genetick\u00fdch rizikov\u00fdch sk\u00f3re<\/a> \u2013 m\u00e1 mal\u00fd alebo \u017eiadny vplyv na spr\u00e1vanie \u013eud\u00ed. Miera fyzickej aktivity, faj\u010denie, konzum\u00e1cia alkoholu a nezdrav\u00e9ho stravovania zost\u00e1va nezmenen\u00e1.<\/p>\n\n\n\n Podobne aj klimatol\u00f3govia<\/a> disponuj\u00fa detailn\u00fdmi znalos\u0165ami o zmene kl\u00edmy, napriek tomu \u010dasto lietaj\u00fa rovnako \u010dasto ako ostatn\u00ed akademici. Samotn\u00e9 znalosti len zriedka ved\u00fa k dlhodobej zmene spr\u00e1vania<\/a>.<\/p>\n\n\n\n Je to prostredie<\/strong><\/p>\n\n\n\n Vysvetlenie pon\u00faka du\u00e1lne procesn\u00e9 modely<\/a> (dual process models) z oblasti behavior\u00e1lnych vied. Na\u0161e spr\u00e1vanie je regulovan\u00e9 dvoma vz\u00e1jomne sa ovplyv\u0148uj\u00facimi syst\u00e9mami. Prv\u00fd syst\u00e9m je pomal\u00fd, reflekt\u00edvny a cie\u013eovo orientovan\u00fd. Vyu\u017e\u00edvame ho pri \u010d\u00edtan\u00ed, osvojovan\u00ed nov\u00fdch zru\u010dnost\u00ed alebo pri odol\u00e1van\u00ed poku\u0161enia. Druh\u00fd syst\u00e9m je r\u00fdchly, automatick\u00fd a riaden\u00fd podnetmi z prostredia, ke\u010f vid\u00edme kol\u00e1\u010d, vezmeme si ho. Pokia\u013e je na\u0161a obmedzen\u00e1 reflekt\u00edvna kapacita plne vy\u0165a\u017een\u00e1, automatick\u00fd syst\u00e9m reaguje priamo na environment\u00e1lne podnety<\/a>. Pr\u00e1ve preto b\u00fdva zmena podnetov v na\u0161om okol\u00ed \u00fa\u010dinnej\u0161ia ako snaha meni\u0165 iba to, \u010do sa odohr\u00e1va v na\u0161ej hlave.<\/p>\n\n\n\n Najsilnej\u0161ie environment\u00e1lne podnety mo\u017eno zhrn\u00fa\u0165 do tzv. \u201e3A\u201c: Affordability, Availability a Appeal.<\/strong> Teda do faktorov dostupnosti z h\u013eadiska ceny (cenov\u00e1 dosiahnute\u013enos\u0165), fyzickej dostupnosti a pr\u00ed\u0165a\u017elivosti.<\/p>\n\n\n\n Affordability: Cena ovplyv\u0148uje spr\u00e1vanie<\/strong><\/p>\n\n\n\n Zvy\u0161ovanie cien tabakov\u00fdch v\u00fdrobkov predstavuje naj\u00fa\u010dinnej\u0161ie politick\u00e9 opatrenie na zn\u00ed\u017eenie prevalencie faj\u010denia. Zv\u00fd\u0161enie ceny o 10% vedie pribli\u017ene k 4% poklesu spotreby tabaku<\/a>. Zdanenie sladen\u00fdch limon\u00e1d<\/a> zni\u017euje ich konzum\u00e1ciu. Naopak spotreba ovocia a zeleniny rastie v pr\u00edpade, \u017ee s\u00fa ich ceny zn\u00ed\u017een\u00e9 prostredn\u00edctvom dot\u00e1ci\u00ed<\/a>.<\/p>\n\n\n\n Availability: Vyber\u00e1 sa to, \u010do je dostupn\u00e9<\/strong><\/p>\n\n\n\n V r\u00e1mci \u0161t\u00fadie, do ktorej sa zapojilo 20 000 zamestnancov z 19 podnikov\u00fdch jed\u00e1ln\u00ed, m\u00f4j v\u00fdskumn\u00fd t\u00edm zv\u00fd\u0161il podiel pon\u00fakan\u00fdch n\u00edzkokalorick\u00fdch obedov a zn\u00ed\u017eil ve\u013ekos\u0165 porci\u00ed kaloricky bohat\u0161\u00edch jed\u00e1l. V\u00fdsledok? Zamestnanci nak\u00fapili o 11,5% menej kal\u00f3ri\u00ed<\/a>, preto\u017ee sa im u\u013eah\u010dil v\u00fdber zdrav\u0161\u00edch variantov.<\/p>\n\n\n\n Appeal: Reklama funguje<\/strong><\/p>\n\n\n\n Z\u00e1kaz reklamy a sponzorstva zo strany tabakov\u00e9ho<\/a>, alkoholov\u00e9ho<\/a> a potravin\u00e1rskeho priemyslu (v oblasti nezdrav\u00fdch potrav\u00edn)<\/a> zni\u017euje pr\u00ed\u0165a\u017elivos\u0165 ich produktov aj ich n\u00e1kup. Podobn\u00e9 efekty mo\u017eno o\u010dak\u00e1va\u0165 aj pri produktoch z oblasti fos\u00edlnych pal\u00edv<\/a>. Zv\u00fd\u0161enie vidite\u013enosti varovn\u00fdch ozn\u00e1men\u00ed a odstr\u00e1nenie zna\u010dkov\u00e9ho dizajnu z obalov taktie\u017e zni\u017euje atraktivitu t\u00fdchto v\u00fdrobkov. Napr\u00edklad varovn\u00e9 etikety na alkoholick\u00fdch n\u00e1pojoch v kanadskom terit\u00f3riu Yukon, ktor\u00e9 explicitne upozor\u0148ovali na riziko vzniku rakoviny v s\u00favislosti s konzum\u00e1ciou alkoholu, viedli pribli\u017ene k 6% poklesu predaja alkoholu<\/a>. \u0160tandardizovan\u00e9 (\u201eplain\u201c) balenie tabakov\u00fdch v\u00fdrobkov navy\u0161e zvy\u0161uje vidite\u013enos\u0165 zdravotn\u00fdch varovan\u00ed, a t\u00fdm \u010falej oslabuje pr\u00ed\u0165a\u017elivos\u0165 zna\u010dky<\/a>.<\/p>\n\n\n\n Pre\u010do je regul\u00e1cia d\u00f4le\u017eit\u00e1<\/strong><\/p>\n\n\n\n V\u00e4\u010d\u0161ina intervenci\u00ed, ktor\u00e9 menia podnety v na\u0161om ka\u017edodennom prostred\u00ed s cie\u013eom ovplyvni\u0165 spr\u00e1vanie, vy\u017eaduje regula\u010dn\u00e9 opatrenia<\/a> pr\u00e1ve preto, \u017ee s\u00fa v rozpore s komer\u010dn\u00fdmi z\u00e1ujmami. \u0160tyri priemyseln\u00e9 odvetvia \u2013 tabakov\u00fd, alkoholov\u00fd, priemysel nezdrav\u00fdch potrav\u00edn a fos\u00edlnych pal\u00edv \u2013 produkuj\u00fa v\u00fdrobky, ktor\u00e9 sa podie\u013eaj\u00fa najmenej na jednom zo \u0161tyroch \u00famrt\u00ed celosvetovo<\/a> a s\u00fa\u010dasne stoja za v\u00e4\u010d\u0161inou emisi\u00ed sklen\u00edkov\u00fdch plynov<\/a> prispievaj\u00facich k otep\u013eovaniu kl\u00edmy.<\/p>\n\n\n\n Napriek tomu na\u010falej preva\u017euj\u00fa informa\u010dn\u00e9 kampane a dobrovo\u013en\u00e1 sebaregul\u00e1cia zo strany priemyslu ako preferovan\u00e9 pr\u00edstupy. Tieto sektory t\u00fato preferenciu akt\u00edvne podporuj\u00fa, prostredn\u00edctvom lobingu, financovania v\u00fdskumu, ktor\u00fd spochyb\u0148uje \u00fa\u010dinnos\u0165 regula\u010dn\u00fdch opatren\u00ed, a r\u00e1movanie vl\u00e1dnych intervenci\u00ed ako obmedzenie osobnej slobody.<\/p>\n\n\n\n \u010co sa potrebuje zmeni\u0165<\/strong><\/p>\n\n\n\n Potrebujeme chr\u00e1ni\u0165 vedeck\u00e9 poznatky aj tvorbu verejn\u00fdch polit\u00edk pred korpor\u00e1tnym zasahovan\u00edm. Oblas\u0165 kontroly tabaku tu pon\u00faka in\u0161pirat\u00edvny model. Krajiny, ktor\u00e9 prijali \u010dl\u00e1nok 5.3 medzin\u00e1rodnej zmluvy o kontrole tabaku, chr\u00e1nili tvorbu polit\u00edk pred zasahovan\u00edm priemyslu, zaviedli politiky<\/a> zalo\u017een\u00e9 viac na d\u00f4kazoch a maj\u00fa ni\u017e\u0161iu mieru faj\u010denia. T\u00fato ochranu je nevyhnutn\u00e9 roz\u0161\u00edri\u0165 na v\u0161etky korpor\u00e1cie produkuj\u00face v\u00fdrobky, ktor\u00e9 po\u0161kodzuj\u00fa na\u0161e zdravie a devastuj\u00fa na\u0161u plan\u00e9tu. Ob\u010dianske zhroma\u017edenia<\/a> a \u010fal\u0161ie formy deliberat\u00edvnej demokracie, v ktor\u00fdch ob\u010dania spolupracuj\u00fa s miestnymi \u010di n\u00e1rodn\u00fdmi vl\u00e1dami, sa z\u00e1rove\u0148 jav\u00ed ako ve\u013emi perspekt\u00edvne n\u00e1stroje. Posil\u0148uj\u00fa tak vplyv ob\u010danov na tvorbu verejn\u00fdch polit\u00edk, ako aj \u00falohu vedeck\u00fdch d\u00f4kazov v rozhodovac\u00edch procesoch.<\/p>\n\n\n\n Praktick\u00e9 odpor\u00fa\u010dania<\/strong><\/p>\n\n\n\n Pre zdravotn\u00edkov<\/strong><\/p>\n\n\n\n 1.<\/strong> Za\u010dnite prostred\u00edm, nie eduk\u00e1ciou.<\/strong> Pri pr\u00e1ci s klientmi \u010di pacientmi sa zamerajte na identifik\u00e1ciu environment\u00e1lnych podnetov, ktor\u00e9 sp\u00fa\u0161\u0165aj\u00fa ne\u017eiaduce spr\u00e1vanie. Namiesto v\u00fdlu\u010dn\u00e9ho d\u00f4razu na motiv\u00e1ciu \u010di znalosti pom\u00e1hajte \u013eu\u010fom pretv\u00e1ra\u0165 ich bezprostredn\u00e9 okolie. Napr\u00edklad: ma\u0165 ovocie na vidite\u013enom mieste a priemyselne spracovan\u00e9 desiaty mimo doh\u013eadu; umiestni\u0165 koleso do chodby namiesto do pivnice; pou\u017e\u00edva\u0165 men\u0161ie taniere a poh\u00e1re.<\/p>\n\n\n\n 2. Podporujte zmeny na pracovisku.<\/strong> Spolupracujte so svojou in\u0161tit\u00faciou na zv\u00fd\u0161en\u00ed dostupnosti a zn\u00ed\u017een\u00ed ceny zdrav\u0161\u00edch mo\u017enost\u00ed v jed\u00e1l\u0148ach. \u0160truktur\u00e1lne \u00fapravy prostredia m\u00f4\u017eu ma\u0165 v\u00fdraznej\u0161\u00ed vplyv ako individu\u00e1lny apel na motiv\u00e1ciu. I relat\u00edvne jednoduch\u00e9 zmeny; napr. nastavenie rastlinn\u00fdch jed\u00e1l ako v\u00fdchodiskov\u00e9 (default) vo\u013eby s mo\u017enos\u0165ou \u013eahk\u00e9ho odmietnutia \u2013 m\u00f4\u017eu v\u00fdznamne posun\u00fa\u0165 spr\u00e1vanie zamestnancov \u017eiaducim smerom.<\/p>\n\n\n\n Pre t\u00edmy verejn\u00e9ho zdravia<\/strong><\/p>\n\n\n\n 1. Zvidite\u013enite to, \u010do zost\u00e1va skryt\u00e9.<\/strong> Vyu\u017e\u00edvajte svoje profesijn\u00e9 aj verejn\u00e9 platformy na to, aby ste komunikovali, ako z\u00e1sadne prostredie formuje \u013eudsk\u00e9 spr\u00e1vanie. Spochyb\u0148ujte dominantn\u00fd narat\u00edv, pod\u013ea ktor\u00e9ho je zmena spr\u00e1vania predov\u0161etk\u00fdm ot\u00e1zkou individu\u00e1lnej v\u00f4le \u010di znalost\u00ed. Dostupn\u00e9 d\u00f4kazy ukazuj\u00fa, \u017ee k\u013e\u00fa\u010dom je premena kontextu, nie iba zmena \u201enastavenia mysle\u201c.<\/p>\n\n\n\n 2. Zapojte tvorcu polit\u00edk.<\/strong> Identifikujte medzery medzi vedeck\u00fdmi d\u00f4kazmi a verejn\u00fdmi politikami, ako na lok\u00e1lnej, tak na n\u00e1rodnej \u00farovni. Oslovujte politick\u00fdch predstavite\u013eov s konkr\u00e9tnymi odpor\u00fa\u010daniami podlo\u017een\u00fdmi empirick\u00fdmi d\u00e1tami. Mnoh\u00ed z nich s\u00fa otvoren\u00ed odborn\u00e9mu vstupu, najm\u00e4 ak obsahuje prakticky realizovate\u013en\u00e9 rie\u0161enia. Napr\u00edklad m\u00f4j list ministrovi zdravotn\u00edctva Spojen\u00e9ho kr\u00e1\u013eovstva viedol k zadaniu synt\u00e9zy d\u00f4kazov zameranej na zmenu spr\u00e1vania s cie\u013eom pred\u013a\u017ei\u0165 d\u013a\u017eku \u017eivota v zdrav\u00ed<\/a>.<\/p>\n\n\n\n 3. Budujte koal\u00edcie pre regula\u010dn\u00e9 opatrenia.<\/strong> Nadv\u00e4zujte spolupr\u00e1cu s organiz\u00e1ciami, ktor\u00e9 presadzuj\u00fa verejn\u00e9 politiky zalo\u017een\u00e9 na d\u00f4kazoch v oblasti tabaku, alkoholu, potrav\u00edn \u010di dopravy. Kolekt\u00edvne advoka\u010dn\u00e9 \u00fasilie je k\u013e\u00fa\u010dov\u00e9 pre vyva\u017eovanie vplyvu priemyseln\u00fdch z\u00e1ujmov. Vyh\u013ead\u00e1vajte pr\u00edle\u017eitosti na pr\u00edpravu preh\u013eadov d\u00f4kazov a odborn\u00fdch stanov\u00edsk podporuj\u00facich silnej\u0161ie regula\u010dn\u00e9 opatrenia \u2013 podobne ako tomu bolo v oblasti kontroly tabaku, kde koordinovan\u00e9 zapojenie expertov do dial\u00f3gu s tvorcami polit\u00edk prispelo k v\u00fdrazn\u00e9mu pokroku.<\/p>\n\n\n\n Prelo\u017eila: Zuzana Dankulincov\u00e1<\/strong><\/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
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