Is health promotion aimed at the wrong target?

By David Hunter

I recently enjoyed this article by Ben Goldacre in the Guardian on vitamin pills and risk compensation – basically arguing that placebos are not harmless, because if we feel we have improved our health then we may take more risks in other areas.

This basically relies on the psychological theory of risk compensation which holds that people have roughly stable levels of risk that they are willing take – if they behave/feel safer in one context then they compensate for this by taking risks in others – this is sometimes given as an explanation for the increase in the deaths of pedestrians that seems to be correlated with the introduction of seatbelts – as drivers felt safer they drive more riskily with unfortunate results for those not surrounded by metal…

In any case this got me thinking about a pet subject of mine, health promotion, and how obsessing about autonomy and information seems to undermine it. What struck me is that if the theory of risk compensation is right then health promotion at least of the “if we just inform them about the risks they will make better choices” is going to be ineffectual. This is because even if the public listen and change their risky behaviour (which frankly they tend not to) they will simply compensation for that lack of risk taking elsewhere.

If risk compensation is right, then it seems to me that there are two viable means of health promotion activity:
1. Get the public to do healthy things for non-health reasons (considerable success has been had promoting sun screen as a preventative for wrinkles – more than when it is promoted for health) or failing this make it unclear how more healthy certain activities are.
2. Aim to modify people’s level of tolerance for risk. This seems to me an interesting approach, which is under explored, perhaps the people looking at human enhancement and moral enhancement might likewise think about increasing people’s sensitivity to risk…

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