Not surprisingly policy-making has been called the “science of muddling through”. This is entirely appropriate because, in spite of the reasonable public expectation that policy is evidence-based, in reality the research shows that it is largely a result of a number of factors including policy-makers’ personal beliefs and values, the opinions of family and friends, financial resources, some evidence, and a whole lot of fear about political ramifications at the ballot box.
Now this really annoys me because policy which is intended to change people’s health behaviours invariably reflects the assumption that if the evidence shows a particular health outcome, and people are educated or informed about this, then they will willingly heed such advice and act in more responsible ways. This view is widespread particularly in health promotion campaigns when people are urged to drink less, eat less, exercise more, and breastfeed endlessly.
But all the research shows that health education is pretty useless. And the reason for that is, just like the policy makers, the choices and actions people make are also based on all sorts of considerations including – yes, you get it – beliefs and values, opinions of family and friends, some evidence and the household budget. (Fortunately most of us don’t have to worry about the effects of our actions on the voting public!)
There should be some recognition that, although people may make decisions which are not consistent with advice promoted by health policy, these are perfectly rational decisions in the context of people’s lives, based on weighing up the various influences and demands on an individual.
So it’s time for policy makers and practitioners in the health arena to get real and realise that when we don’t follow policy advice and change our unhealthy behaviours, it’s not about a ‘health literacy’ failure (whatever that is), or non-compliance, or stupidity or stubbornness, but just that – like the decisions made by policy-makers – for most of us life in general is often about “muddling through” as best we can.