Lifestyle Drift, Waning Influence of the Past, Victim Blaming, Citizen Shift and Residual Effects Health issues will often be explained in terms which either place responsibility for their cause and resolution within the individual or social realm. Logically, in an attempt to resolve these health issues this leads to health interventions either being designed to focus on changing the lifestyles of individuals (i.e., promoting behaviour change) or changing society and the social order (i.e., addressing the social determinants of health). Take the issue of obesity for example. Some would argue that obese people lack willpower and are therefore obese because they are irresponsible and lazy. Alternative explanations will point to social factors such as higher rates of obesity in poorer sections of society resulting from restricted access to physical activities and healthy food in the areas they tend to live and long working hours leading to more affluent sectors of society feeling less inclined to exert themselves or restrict their diets during their time away from work. Some people argue that without addressing the social determinants of health – and thus making society more equal – interventions designed to promote behaviour change will most likely only increase inequality (this is because people who are better off tend to be more able to follow health advice than others). Despite this well-formed argument a trend has developed within health policy known as ‘lifestyle drift’. This is a process whereby instead of addressing the social determinants of health - e.g., employment, housing, access to welfare and health care - increasingly health policies and interventions focus on promoting behaviour change e.g., campaigns which encourage people to stop smoking, limit alcohol consumption, eat a healthy diet and increase their physical activity. My research indicates that, unfortunately, even when policies do set out to address the social determinants of health these polices tend to eventually revert back to individualised interventions designed to promote behaviour change. During my research in a deprived area I observed an initial surge in socially-conscientious interventions - designed to help and support local residents - eventually give way to an approach which largely ignored these social factors and instead expected individuals to simply ‘step up’ and take more responsibility (as if they were simply choosing not to live healthier lifestyles). I have described this gradual transition as ‘the waning influence of the past’. This describes and explains how this initial commitment to resolving the social determinants of health can weaken over time. This is of particular importance because, ultimately, this process can lead to a reversal of initial intentions and thus exacerbate existing issues rather than resolve them. Often this can lead to what is known as ‘victim blaming’: identifying a vulnerable group and then framing the issues they face in such a way as to position them as responsible– and thus blameworthy – for the problems they experience. Addressing the social determinants of health is expensive and thus often governments are reluctant to appropriately tackle them. Therefore, the waning influence of the past can partly occur because interventions lose funding which leads to those delivering them seemingly having no other choice but to revert to the cheaper option of shifting responsibility for health away from governments and corporations and to individual citizens: this is a process I have described in my work as ‘citizen shift’. An example of how this might be done is initially providing a smoker with nicotine patches and then, when funding runs out, using the example of the initial help to entirely shift the responsibility for them quitting to the individual. Obviously, doing this is inappropriate and unhelpful as nicotine patches do not address the underlying (and deeply social) reasons why somebody may smoke. I have termed such victim blaming as a ‘residual effect’ of health interventions: a situation whereby the example of past health interventions are used by people in positions of power to shift blame and responsibility to a vulnerable group and then frame their ‘failure’ in individualistic terms without acknowledging the social circumstances acting upon them or the fact that the intervention has ‘failed’. A specific example I observed in my research was a local council building a leisure centre in a deprived area to compensate for the lack of local opportunities. Initially services were also delivered to help local people to access the leisure centre by offering cheap activities, childcare and one-to-one personal support. However, as funding ran out these interventions ceased to be offered and instead local people were simply expected to be more physically active just by virtue of now living in close proximity to a leisure centre. This led to people in positions of power blaming local people for their lack of physical activity and general poor health even though previously it had been recognised that the roots of these issues were social rather than individual, e.g., high levels of unemployment, low household incomes, etc. Hopefully, you can see how this example demonstrates all five concepts: lifestyle drift (i.e., focus on physical activity), the waning influence of the past (i.e., initially offering social support but then reducing this necessary support over time), citizen shift (i.e., shifting the responsibility for a social issue onto the individual), residual effect (i.e., using the example of a past intervention to blame a vulnerable group for not participating even though they are no longer receiving the support it is necessary for them to do so) and victim blaming (i.e., overlooking significant social factors to stigmatise the behaviour of a vulnerable group).
DEADLINE: 29/1/16
CONTACT OLI: o.s.williams@bath.ac.uk