WHO, Do lifestyle changes improve health?

Do lifestyle changes improve health?

9 January 2009 — Can lifestyle changes really improve people’s health? In this episode we look at the evidence from new research.

Transcript of the podcast

Veronica Riemer: You’re listening to the WHO podcast. My name is Veronica Riemer and this is the first podcast of 2009, episode number 56.

The evidence for the importance of healthy lifestyles is now overwhelming. New research conducted in Iran shows that lifestyle changes in diet and levels of physical activity improve the health of entire communities. Results of the research have appeared in the January issue of the Bulletin of the World Health Organization.

In the research project — called «A Healthy Heart» — mass media was used to educate people about healthy nutrition, food labels, the introduction of half portions in fast food restaurants and healthy snacks in schools. To encourage people to undertake physical activity, the government announced automobile-free days and built bicycle lanes in cities. Smoking was banned in the workplace.

Diet, physical activity and smoking behaviour were assessed annually for four years in the intervention areas and for three years in the control area. Changes were most notable in the diet of the research participants. In one area, 14% of participants had a healthy diet at the beginning of the study. This increased to 30% after four years. Time spent on leisurely physical activity increased from 81 minutes to 181 minutes per week. Smoking declined but not significantly.

Dr Tim Armstrong from the WHO Department of Chronic Diseases and Health Promotion tells us how a healthy lifestyle makes a difference.

Dr Tim Armstrong: Noncommunicable diseases such as cancer, cardiovascular disease and diabetes account for 35 million deaths each year. This is 60% of all deaths. And these diseases have common risk factors: tobacco use, inappropriate diet and physical inactivity. By avoiding these risk factors in the first place, by preventing the risk factors, we can prevent the majority of deaths due to those diseases.

Veronica Riemer: We know that lifestyle-related chronic diseases are placing an increasing burden on health systems around the world. Can a small change in behaviour such as diet, or physical exercise, really make a difference to an individual’s health?

Dr Tim Armstrong: Certainly we believe that prevention is the best answer to the problem. We can prevent these diseases by small changes in people’s behaviour. For example, 30 minutes of moderate physical activity each day, that is the equivalent of a brisk walk, can reduce your risk of a heart attack by up to 50%. Increasing your fruit and vegetable consumption can reduce your risk of colon cancer by up to 50%. So these changes are real, they are achievable. What we as WHO, and of course governments are encouraged to, do is to create the policies and the environment for people to be able to make these small choices. The health benefits are there, they are real, they are measured and they are cost effective.

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Veronica Riemer: Can you tell me a little bit about the most effective interventions in changing people’s behaviour and what kind of behaviour are we hoping to change?

Dr Tim Armstrong: The sorts of interventions vary for the sorts of risk factors. What we do know in general is that we have to target our population. We have to give key messages in terms of education. We have to create the environment for these interventions to be effective. For example, to increase physical activity, the population has to be educated to the importance of physical activity, but if we don’t have the environment, i.e. a safe place to be physically active, the education programme will not work. We have to ensure that the whole environment is one where people can make the healthy choices.

Veronica Riemer: Do you feel that government restrictions are the only way to effect real behaviour change, such as heavily taxing tobacco and alcohol or subsidizing the use of public transport or building bicycle lanes?

Dr Tim Armstrong: Government restrictions can be very effective. The example with tobacco is one where we know that increasing the taxation on cigarettes has a real effect on the consumption of tobacco. But it is not the only thing we can do. Of course, education campaigns, banning of advertising of cigarettes, and of course restricting the sale and access to cigarettes are also very important.

Veronica Riemer: The programme was obviously a success in Iran. Are there plans to introduce similar programmes in other developing countries? And would these programmes have to be tailored to meet specific country needs?

Dr Tim Armstrong: The programme in Iran is an excellent example of a multi-component series of interventions to increase physical activity and improve diets. The principles of the programme in Iran are the principles that can be applied to other developing countries. Of course, one thing we do know is that all interventions must be tailored to the appropriate situation: we look at the cultural aspects, the country’s needs, the country’s capacities.

Veronica Riemer: You can find more information on this at www.who.int/topics/chronic_diseases.

The WHO Bulletin is available free online at http://www.who.int/bulletin.

That’s all for this episode of the WHO podcast. Thanks for listening. If you have any comments on our podcast or have any suggestions for future health topics drop us a line. Our email address is [email protected]

For the World Health Organization, this is Veronica Riemer in Geneva.


The Basics of Prosocial Behavior

Prosocial behaviors are those intended to help other people. Prosocial behavior is characterized by a concern for the rights, feelings, and welfare of other people. Behaviors that can be described as prosocial include feeling empathy and concern for others and behaving in ways to help or benefit other people.

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In The Handbook of Social Psychology, C. Daniel Batson explains that prosocial behaviors refer to «a broad range of actions intended to benefit one or more people other than oneself—behaviors such as helping, comforting, sharing and cooperation.»

The term prosocial behavior originated during the 1970s and was introduced by social scientists as an antonym for the term antisocial behavior.

What Motivates Prosocial Behavior?

Prosocial behavior has long posed a challenge to social scientists seeking to understand why people engage in helping behaviors that are beneficial to others, but costly to the individual performing the action. In some cases, people will even put their own lives at risk in order to help other people, even those that are complete strangers. Why would people do something that benefits someone else but offers no immediate benefit to the doer?

Psychologists suggest that there are a number of reasons why people engage in prosocial behavior. In many cases, such behaviors are fostered during childhood and adolescence as adults encourage children to share, act kindly, and help others.

Evolutionary psychologists often explain prosocial behaviors in terms of the principles of natural selection. Obviously, putting your own safety in danger makes it less likely that you will survive to pass on your own genes. However, the idea of kin selection suggests that helping members of your own genetic family makes it more likely that your kin will survive and pass on genes to the future generations. Researchers have been able to produce some evidence that people are often more likely to help those to whom they are closely related.

The norm of reciprocity suggests that when people do something helpful for someone else, that person feels compelled to help out in return. Essentially, helping others means that they might help us in return. This norm developed, evolutionary psychologists suggest because people who understood that helping others might lead to reciprocal kindness were more likely to survive and reproduce.

Prosocial behaviors are often seen as being compelled by a number of factors including egoistic reasons (doing things to improve one’s self-image), reciprocal benefits (doing something nice for someone so that they may one day return the favor), and more altruistic reasons (performing actions purely out of empathy for another individual).

Situational Influences on Prosocial Behavior

Characteristics of the situation can also have a powerful impact on whether or not people engage in prosocial actions. The bystander effect is one of the most notable examples of how the situation can impact helping behaviors. The bystander effect refers to the tendency for people to become less likely to assist a person in distress when there are a number of other people also present.

For example, if you drop your purse and several items fall out on the ground, the likelihood that someone will stop and help you decreases if there are many other people present. This same sort of thing can happen in cases where someone is in serious danger, such as when someone is involved in a car accident. In some cases, witnesses might assume that since there are so many other people present, someone else will have surely already called for help.

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The tragic murder of a young woman named Kitty Genovese was what spurred much of the interest and research on the bystander effect. In 1964, Genovese was attacked as neared her apartment on her way home from work late one night. She was stabbed and left lying on the sidewalk. She called for help and reports later indicated that many of her neighbors heard her cries yet did not call for help or attempt to interfere with the attack that lasted approximately 30 minutes. A neighbor eventually called police, but Genovese died before reaching the hospital.

The story generated considerable interest in the bystander effect and in understanding why people help in some situations but not in others, and experts have discovered a number of different situational variables that contribute to (and sometimes interfere with) prosocial behaviors.

  • First, the more people that are present decreases the amount of personal responsibility people feel in a situation. This is known as the diffusion of responsibility.
  • People also tend to look to others for how to respond in such situations, particularly if the event contains some level of ambiguity. If no one else seems to be reacting, then individuals become less likely to respond as well.
  • Fear of being judged by other members of the group also play a role. People sometimes fear leaping to assistance, only to discover that their help was unwanted or unwarranted. In order to avoid being judged by other bystanders, people simply take no action.

Lantane and Darley have suggested that five key things must happen in order for a person to take action. An individual must:

  1. Notice what is happening
  2. Interpret the event as an emergency
  3. Experience feelings of responsibility
  4. Believe that they have the skills to help
  5. Make a conscious choice to offer assistance

Other factors that can help people overcome the bystander effect including having a personal relationship with the individual in need, having the skills and knowledge to provide assistance, and having empathy for those in need.

Prosocial Behavior Versus Altruism

Altruism is sometimes seen as a form of prosocial behavior, but some experts suggest that there are actually different concepts. While prosocial behavior is seen as a type of helping behavior that ultimately confers some benefits to the self, altruism is viewed as a pure form of helping motivated purely out of concern for the individual in need.

Others argue, however, that reciprocity actually does underlie many examples of altruism or that people engage in such seemingly selfless behaviors for selfish reasons, such as to gain the acclaim of others or to feel good about themselves.


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