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Raising the Grade on Chronic Disease

featured / health research / public health / behavioral research

Over the past two decades, the American Public Health Association (APHA) has put on National Public Health Week (NPHW) during the first full week of April. Each year, NPHW focuses on public health issues in the United States by bringing together national, state, and local partners to highlight areas of improvement for our nation. Today marks the first day of NPHW 2015, which is themed "Raising the Grade."

The driving force behind "Raising the Grade" is the recognition that even though the U.S. is rife with high-quality doctors, procedures, and pharmaceuticals, we are still behind other countries in key areas such as life expectancy, infant mortality rate, and prevalence of chronic disease. In particular, as noted on the NPHW website, rates in the U.S. for heart disease, obesity, and diabetes are some of the highest in the world.

Chronic Disease

The Centers for Disease Control and Prevention (CDC) recently identified chronic disease as the "public health challenge of the 21st century." This is not surprising given that chronic conditions (e.g., heart disease and stroke, cancer, diabetes, arthritis, obesity, respiratory diseases) are the leading causes of death and disability in the U.S., and more than 75% of U.S. health care spending is attributed to people with these conditions.

What makes these statistics especially distressing is that chronic diseases are among the most preventable health problems. According to CDC, "four modifiable health risk behaviors—lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption—are responsible for much of the illness, suffering, and early death related to chronic diseases." People can be motivated to take charge of their health and modify their behaviors if given the necessary education and support to do so.

The question for public health researchers and practitioners is how to motivate people through education, support, and a bit of persuasion.

Education and Influence

Messages designed to inform and influence people at risk for chronic diseases might have a dual purpose, but that does not mean the two goals can't complement each other. As we've talked about before, messages that incorporate statistical information about risk or narratives that suck the target audience into the story can impact people's behavior in powerful ways. In addition to this, it is important not to design any messaging or visual elements that could be perceived as an attack on the target audience—if people at risk for chronic diseases believe they are being harshly criticized, it is unlikely that they will respond positively to the message.

Not Me

Let's consider the "Not Me" campaign from the state of Washington. Some of the campaign's messages (1) give numerical information about the risks and prevalence of diabetes, (2) present images of similar others engaging in activities to help reduce risk, and (3) give simple, action-oriented direction on how to reduce risk. Such a message blends statistical and narrative elements into a message that is at once educational and persuasive.

There is also an opportunity for us to serve as our intrapersonal and interpersonal sources of education and influence. At the end of the day, we can be the sources of education and influence for ourselves, for our friends, and for our family. As part of NPHW, APHA has created a first step in this process. By going to their website, you can pledge to take command of your health and to join in reaching out to others. This first step is part of the commitment-consistency principle: By publicly committing to a course of action (eating well, exercising regularly, etc.), you have already increased the odds that you will follow through on the commitment.


Social Support

Education and influence are critical to facilitating healthy behavior change. However, social support is also a key part of helping those who are at risk for or currently suffering from chronic diseases. Without tangible support (concrete or physical aid), informational support (advice and guidance), and emotional support (encouragement and concern), how can we expect people to engage in more physical activity, improve their diet, and abstain from tobacco and alcohol use? These elements of social support are particularly important when thinking about what we can do interpersonally to help protect against chronic diseases.

Beyond guarding against the physical toll that a chronic illness takes, it is important to consider a sufferer's mental health. Whether depressive symptomology is a cause or an effect of chronic disease, one thing is clear: The two are linked. It is clear that beyond facilitating the adoption of healthy behaviors, social support additionally serves to buffer against stressors that are precursors to or outcomes of chronic illness. So throughout this year's National Public Health Week, let's also remember to give kind words to those who may be especially needful of them: The people fighting difficult battles against conditions such as heart disease, diabetes, obesity, and arthritis.

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