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LIFESTYLE - A plea to abandon the use of this word in public health

by Paul Lincoln, CEO UK Health Forum

I am becoming increasingly concerned at the widespread and unquestioning use of the term “lifestyle” in public health  

I believe the term lifestyle or lifestyle factors should be completely abandoned by public health professionals. It frames public health at an individual level - effectively blaming individuals for making irrational decisions that are detrimental to their health.

The use of such descriptive terms frames public health actions in a pejorative and reductionist way, demonstrating that those who use them seemingly fail to understand or communicate the broader nature of the range of determinants of health; thus perpetuating myths about the foundations of health and health inequalities. 

“Lifestyle” is a loaded term that reinforces stereotypes about individuals and a world view that people are majorly or entirely responsible for their own health. Indeed surely the term “deathstyle” would be better because the logical implication is that most individuals in our society are consciously choosing to lead unhealthy lives. Using such a term ignores the many and varied influences on health; the implicit assumption is that all is solved by developing an individual’s rational health decision making capacity.

It is clearly nonsense to talk about smoking and alcohol dependency as a lifestyle choice when they are recognised as addictions. And what about the very young or vulnerable populations? There are many significant influences on one’s health which you cannot control.

Lifestyle must not be confused, or used loosely, as shorthand to describe the range of contributory determinants of health and disease. That would be totally inaccurate and misleading. Avoidable chronic diseases and conditions are determined by a range of behavioural, environmental and social factors that affect exposure over time to known risk and protective factors. 

The use of the term lifestyle essentially conveys an ideological view that risk exposure is voluntary and down to free choice. Therefore the extended logic is that individuals determine their own health futures. This framing of the concept and mindset suits certain ideological views and helps industries that produce health harming goods escape responsibility. It also helps those who wish to negatively frame public health in terms of the nanny state. Indeed referencing lifestyle is tantamount to victim blaming and can be part of the discourse to limit access to health services.   

How words are used in the familial context shapes the way we think conceptually, consciously and subliminally. It conveys underpinning prejudicial values, often without question. This certainly applies to the term lifestyle.

It is thus a serious disservice to the public health community to peddle such terms. It is certainly a professional disservice and discourtesy to the public. It actively undermines public health interventions by ignoring upstream causes and alienates people from the services intended to help them.

The focus on “lifestyle“leads to a predominant focus on the downstream causes . It negates the search for more effective solutions based on tackling the “causes of the causes”, for which solutions are upstream, more cost effective, ethical, and are not iniquitous. 

The unquestioned and ill considered usage of the term lifestyle is a harmful and unethical determinant of bad public health practice and I believe it will become increasingly anachronistic and viewed with disbelief by future generations of public health professionals.

The term lifestyle originates from the language of marketing. Thus health is trivialised as a commodity! How are we going to develop a more health literate public and a wider community of professionals if we effectively patronise them and do not widen the health debate?

I would implore public health agencies and professionals to abandon the glib, lackadaisical and incorrect use of this term to describe health determinants. Public health professionals talk about a new narrative on prevention and in the same breath talk about healthy lifestyles! There is a real and present danger that using such language could set back the public health agenda by decades.

I would look to the public health community to set the standards not lower them. I cannot imagine the term “lifestyle” being included in any proper public health taxonomy. Instead, as the public health community, we should describe accurately the range of health and disease determinants or use the description “behavioural determinants” which are socially, economically and environmentally patterned. Let use evidence based language please and think more carefully about what we are (mis) communicating! 

Let’s have a debate among the wider public health community and consider alternative and more accurate and meaningful ways of describing what we are wishing to communicate. Do you agree? Suggestions welcomed. 

Paul Lincoln, UK Health Forum 

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