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MSc Global Public Health
OMED-1375
BEHAVIOUR CHANGE & HEALTH PROMOTION M02
Change4Life and Health Belief Model – A Critique
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Introduction
The health promotion strategies are focused on promoting health and bringing about a change
in the behaviour of individuals to prevent the occurrence of conditions contributing to ill health.
According to the World Health Organisation [WHO] (2021), the concept of health promotion
refers to the process wherein people are given the power to increase the control of their health
and also improve it. Change4Life is one such health promotion campaign that focuses on
healthy eating and regular exercise (Change4Life, 2021). The campaign identifies obesity as a
burden on the health infrastructure, as it puts the population at risk of health complications like
diabetes and heart ailments. Thus, the program focuses on the growing population and ensures
support to parents for helping them in making healthier choices for their children.
The purpose of the essay is to analyse and critically review the campaign while focusing on the
global targets of health promotion following The Ottawa Charter for Health Promotion.
Through the essay, the campaign is discussed and a justification is provided about the context
of the integrated strategy. The critical analysis of the strategy in sync with the global health
promotion targets is also presented in the essay. Finally, the application of behaviour change
theory in the health promotion strategy is critiqued concerning the social, cultural and ethical
elements of appropriateness.
Health Promotion Strategy: Change4Life
Change4Life is the health promotion strategy that is aimed at bringing about a change in the
possible future health burden from obesity through the integration of planned efforts towards
awareness of healthy habits inclusive of eating healthy and exercising regularly (Change4Life,
2021). The targeted population of the campaign includes parents and children who can be
taught about making a shift towards a healthy lifestyle, which when instilled at an early stage
can continue to adulthood and further ahead. In the work, by Garden and Wood (2018) it is
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mentioned that the habits are formed through consistency, which can be achieved through the
provision of external support. The introduction of fun ideas under the Change4Life campaign
with Disney-inspired games for getting the children to move around and healthy yet easy
recipes for busy weeknights is what the strategy proposes (Change4Life, 2021). It is focused
on bringing about a change in the behaviour of the individuals.
The campaign is linked with the Health Belief Model [HBM], which suggests that the belief of
individuals play an important role in their decision to accept the interventions that can benefit
their life. Sulat et al. (2018) mentioned in their research conclusions that the predictability of
an individual to adhere to healthy living behaviour can be forecasted based on the faith that
they develop towards the treatment or intervention considering the threat looming on their
current and future health. The integration of HBM in the introduction of a healthy lifestyle and
eating can therefore be justified based on the understanding and faith in intervention at the right
age, which can help prevent obesity and consequential ailments in children. As discussed in
the work by Omotola (2020), the introduction of educational intervention boosts the knowledge
of the targeted population and builds their belief in the interventions suggesting behavioural
changes for healthy living.
Global Health Promotion Targets and Change4Life: A Critique
The global health promotion targets are given under The Ottawa Charter for Health Promotion,
1986 focus on three core elements i.e., enable, mediate and advocate with key action areas
being building healthy public policy, reorientation of health services, creation of a supportive
environment, development of personal skills and strengthening of community action (WHO,
2021). The global health promotion targets focus on advocating good health by making
political, economic, social and cultural conditions favourable to individuals. In the work by
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Baker et al. (2017), it is mentioned that public policies are introduced for the advocacy of good
health.
Change4Life is a government-funded program introduced to advocate a healthy lifestyle for
the prevention of obesity. The concept of bringing about a change in the eating habits and
introducing physical activity promotes better health but does not take into consideration the
differences that exist in social, economic, behavioural and biological factors (Piggin and Lee,
2011). All the targeted parents cannot provide their children with healthy alternatives and
introduce 5 portions of fruits and vegetables daily, as suggested in the health promotion
campaign (Change4Life, 2021). While not all the individuals in the targeted population have
the education to understand how obesity can impact the future of their children; it is also not
recognised under the campaign that there are biological differences that have an impact on the
body’s metabolic activities of different individuals. Ghosh and Bouchard (2017) mentioned in
their study that the issue of obesity is linked with different variables inclusive of biological,
genetic and behavioural aspects. Change4Life focuses only on the behavioural aspects of
individuals and does not take into consideration the genetic makeup that may lead to obesity.
Thus, the global health promotion target of advocating good health, healthy lifestyle for the
prevention of obesity, is not achieved appropriately by Change4Life.
Secondly, from the lens of mediating the health promotion plan, Change4Life is a campaign
being advertised and mediated as a health persuasion with the government backing the policy
and targeting the desired population through the suggestion that the changes are based on expert
advice (Change4Life, 2021). The process of motivating the individuals with the fact that they
can take charge of their life by making healthy choices brings out the fact that it is all about
individual-level changes (Basińska-Zych and Springer, 2021). The priority action area of the
global health promotion targets suggesting the development of personal skills should be
achieved through the individual level changes to be made. However, Change4Life (2021) does
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not provide individual assistance in dietary planning and has its limitations in the area. Sallis
(2018) mentioned in his work that the intervention plan for health promotion needs to be
developed following the desired outcomes to be achieved, which for individual-level change
requires relevant support. A coordinated action supported by different sectors is required to
further implement Change4Life successfully.
The campaign does not meet the ‘to enable’ strategy of The Ottawa Charter, which suggests
that the differences in the current health status should be reduced and all individuals should
have access to the relevant knowledge and information. It is an underlying assumption of the
campaign that reach targeted individual possesses the knowledge on obesity and healthy eating
habits. The campaign also suggests that the consumers switch to foods that are lower in fat and
turn more processed as an initiative of dairy swaps (Change4Life, 2021). However, there is a
lack of understanding among individuals about the dangers of making such dairy swaps. It is
criticised considerably, as against the natural fats present in butter; the low-fat spreads contain
trans-fat, which is attributed as dangerous in the long-term consumption (Shrivastava and
Shrivastava, 2020). Thus, the campaign and its suggestions are in contradiction to the bans
being put on the consumption of trans-fat across the UK and even across world food chains.
Thus, it can be concluded that despite the effort to bring a change in people’s lifestyle for better
health, Change4Life has several aspects that need an improvement for better efficacy in terms
of global health targets.
Health Belief Model Critique: Socially, Culturally and Ethically
The public health policies have adopted the deontological approach wherein the consequences
of the action do not matter and instead it is about the morality of the action. There are not just
social and cultural limitations in the application of HBM but also ethical perspectives to be
taken into consideration. According to WHO (2021) health is a resource of everyday life and
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therefore it should go beyond the lifestyle of individuals to their wellbeing. The determinants
of health are interwoven and the health of individuals cannot be transformed just by the focus
on their lifestyle.
The general socio-economic conditions of the individuals play a determining role in their health
and ability to maintain a healthy lifestyle. Medvedyuk, Ali and Raphael (2017) discussed in
their work that the living and working conditions of the individuals including their employment
prospects impact their ability to access health services. HBM does not take into consideration
the factors of social living standards of the individuals. The inability of individuals to
understand and implement the required changes in their lifestyle can be limiting for the health
promotion approach, which is not perceived as a possible obstruction under HBM. The
optimum health promotion can be achieved when there is specific consideration and provision
of opportunities to those who have the least ability to resist the influences leading them to poor
health. The assumption of the model that all individuals have the same level of knowledge and
information about the disease being targeted forms the primary criticism. In the discussion
presented by Nourian et al. (2020), it is concluded that there are differences in the
understanding developed towards a health promotion plan among individuals based on their
education level. The application of HBM in the Change4Life campaign presented the challenge
suggesting that all the targeted parents have knowledge about obesity and its consequences on
the children in their adulthood.
The HBM does not consider the attitude and behaviour of individuals revolving around their
habits and also the perceptions about not adopting the changes amid non-health-related issues,
which are the cultural and social elements. The differences in the perception of individuals
about the health prospects are not taken into account by HBM, which can be linked to the
different definitions of obesity among different cultures. The work by Burten, White and
Knowlden (2017) highlighted that African American adults are culturally tailored obese due to
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their perception of obesity being different from the other parts and other cultures of the world.
Thus, environmental influences like culture are not considered under the HBM model leading
to its limitations. Moreover, HBM is highly descriptive, which refers to the inability of the
model to focus on precise and comprehensive aspects. There is a lack of association with the
perception about the severity of the health behaviour for the environmental and economic
factors are not taken into consideration. As a result, a lack of equality in the model arises, which
is inhibitory and limiting in its application.
The ability of individuals to adopt the changes as per the HBM interventions is also an
assumption with no consideration given to the differences in economic conditions of the
participants. The differences in the implementation of a health promotion plan lead to the rise
in inequality and therefore the level of justified application and fairness is set below the
intended outcomes (Fernandez et al., 2019). As HBM does not take into consideration the
impact that incapacity to adopt the intervention has on the outcomes, there is social and ethical
inappropriateness attached to it. The most crucial elements of ethical inappropriateness of
HBM include the lack of autonomy in the model with individuals assumed to be readily
accepting the health promotion suggestion (Beauchamp and Childress, 2009). On the contrary,
HBM does exist in sync with the principle of beneficence and non-maleficence of medical
ethics, as the assumptions are based on what is best for the individuals and do not harm them.
Conclusion
The essay focused on the health promotion strategy developed to promote the health of the
individuals. In the discussion, the Change4Life campaign was critically evaluated, which is
focused on the prevention of obesity through the inclusion of healthy eating and regular
exercising. The approach integrated into the campaign is the behavioural theory of the Health
Belief Model, which suggests that the belief of individuals in the intervention’s ability to
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promote their health is essential. Following the global health promotion targets, it is revealed
that the integration of the Change4Life program is a government-funded program mediated to
individuals for bringing about a change at the individual level and advocated for health
promotion. However, it fails to enable all the targeted individuals to adopt the required changes
due to the differences in the economic conditions and knowledge about the targeted health
issue. The integration of the HBM to the Change4Life campaign is faced with criticism due to
the lack of acknowledgement of behavioural and cultural perceptions of the individuals. Thus,
an unjust and unfair outcome is yielded by HBM but while maintaining the principles of
beneficence and non-maleficence.
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