Is health literacy the cause of the Western fitness boom?
The current fitness and health boom in Europe and the West may not be the result of health educators’ work or increased health literacy, argues health researcher Dr Wolfgang Dür. The boom may, however, allow health educators and researchers to turn their attention to the pressing lack of research into health literacy.
Recently, one of my students graduated with a master’s thesis on body self-improvement. Research in this field is about individualisation and the self-referent practices people use to generate a self and to present themselves in social contexts.
For example, research looks at behaviour likely to mould and frame a person’s body – or at least its appearance – such as physical exercises, dieting and eating habits, or the use of fashion, makeup and cosmetic products. Although this field is not about health or health literacy, it is quite interesting to put our ‘health-glasses’ on and look at the motifs and rationales behind such behaviour, and to ponder the relevance of health and health literacy in this context. Is the fitness boom – with hugely popular manifestations such as CrossFit, gym exercise and running – the result of health researchers and educators’ hard work?
Four main motivations for self-improvement
Looking at my student’s data, there seem to be four predominant types of motivation for turning a person’s attention to their own body:
- the immediate emergence of good feelings and wellbeing, especially when doing sports;
- narcissistic satisfaction from feeling beautiful and sexually attractive;
- ethical and/or political concerns about biodiversity, animal rights, industrial food production, pollution etc.;
- adaptation to medium levels of socially expected looks and behaviour to feel ‘normal’.
The last motivation, which seems to be the most frequent, could be paraphrased by: ‘I definitely don’t want to stick out, not for the good, even less for the bad. I just want to lead a simple and average life!’
Fitness boom might not be all about health
Without stressing the limited evidence of such a small qualitative study (and even less of my summary of the findings!), I think it reveals something typical about health literacy.
First, health is still not the main driver of motivation for young adults. Whatever they do in terms of healthy lifestyles, they do not think of preventing cancer, increasing fitness and productivity, or reaching Methuselah’s age without needing home nursing. They do it for fun, for narcissistic feelings, for political or ethical arguments, to be part of the mainstream, and eventually – to receive proprioceptive feelings of being themselves.
Second, many researchers, health educators and experts in health promotion still assume that whatever individuals do is the result of an individual decision based on information or knowledge. These researchers measure health literacy as an individual competence and attest catastrophic deficits to a majority of the population. However, as it has been shown by the PIAAC studies, the information processing skills of people are very limited and the probability to increase them in less than one or two generations is very low. Only 9%-12% of people have sufficient abilities to handle successfully the complex life circumstances of modern societies; for about 50% of people, these circumstances are overwhelming. Therefore, most people act like the ‘adapters’ from point 4 above and evaluate what is ‘normal’ before acting. Some call this phenomenon ‘pluralistic ignorance’.
Thirdly, health literacy must be seen as a systemic characteristic: it is an ability of the health care system and the public health system. It is about readability, understandability and usability of materials, about medical professionals’ communication skills, and most importantly – about the organisational constraints and the self-explaining usability of structures and processes for everyone. As for the public health systems in most OECD countries, there is a tremendous lack of research regarding these problems, regarding the development of solutions, and above all – the political and practical measures to unleash and guide change.
So, the answer to the preluding question is probably ‘no’. The fitness and sports boom is not likely to be an effect of health literacy initiatives and education. Conversely, will this boom have an impact on health literacy? After all, that could facilitate health literacy practitioners and researchers to get individuals to be more active, so they can focus their efforts on other more relevant issues.
Dr Wolfgang Dür is the director of the Vienna Institute for Health Research in Vienna, Austria.
Priv.Doz. Mag. Dr. phil. Wolfgang Dür
Director of the Vienna Institute for Health Research
A-1190 Vienna, Hackhofergasse 8-10