How to motivate better health.

There is ample evidence that changes in lifestyle and personal habits enhances health. Programs that promote good habits and prevent disease ought to mean a healthier population, with reduced costs for medical care. However, there are obstacles to altering the health habits of large numbers of people, according to Stanford University psychologist Albert Bandura. "The quality of health of a nation is a social matter, not just a personal one. It requires changing the practices of social sytems that have detrimental effects on health."

Large-scale changes are essential, but often slow in coming, he notes, but the encouraging news is that people don't need to wait for leaders at the top to act. There are many ways that a local community can affect its members' health for the better.

Bandura says it is important to base a program on knowledge about what motivates and enables individuals to modify behavior. Traditional biomedical approaches to promoting health, where a doctor simply tells a patient, "You should quit smoking" or "You really ought to exercise more" do not work for most individuals. "Health promotion and risk reduction programs are often structured in ways that are costly, cumbersome, and minimally effective. The net result is minimal prevention and costly remediation."

He cites several examples of health promotion initiatives that do work, because they are based on a solid understanding of change and because they support individuals in making changes. A solid health-promotion theory should be based on knowledge about self-regulation--why people acquire harmful habits, how those habits operate, and how to modify them to enhance human health.

Beliefs about how much individuals can achieve by their own efforts will influence whether they even consider changing health habits, whether they have the motivation and perserverance to succeed, how well they maintain the habit modifications they have achieved, their vulnerability to relapse, and their success in restoring control after a setback.

The most successful...