The way that we live our lives has an impact on our health. What might seem like small choices made today can have a large impact on our life expectancy – but perhaps more importantly, our health and how well we feel during those years of life. It is a common myth that people who live a long time have a long time in poor health; the opposite is true. At a population level, those groups of people who live the longest actually spend the shortest time in poor health.
So how do we help people to make healthier choices?
- ‘Agency’ is about the ability of individuals to make their own decisions and to enact them. In this context, we would need people to understand the benefits that healthier lifestyles can offer and to want to aspire to those benefits, to understand what to do, and then to make the changes and to sustain them.
- ‘Structure’ are those factors of influence which affect the person’s agency. They could be linked to social, cultural or economic factors and are often very well established. For some groups (and some choices), they might provide support for change or they might form barriers for change.
Exactly how agency and structure influence our ability to make and sustain healthier choices is much debated; there are undoubtedly many factors that influence these and that is why supporting people to make healthier choices is complex and nuanced.
Plymouth recognises both of these, and also that structural factors in more deprived groups tend to form barriers to healthier behaviours. This philosophical basis for Thrive Plymouth is important to acknowledge since it recognises that although individuals have responsibility for actions that affect their health, positive actions could be enabled by changes to the structural contexts in which health-related choices are made.
Plymouth was adopted by Plymouth City Council on 11 November 2014. It strongly reflects the Council’s endorsement of the Marmot policy objective of strengthening the role and impact of ill health prevention. It provides a mechanism for achieving the NHS Forward View aspiration of a radical upgrade in prevention and public health. Finally, it is a key delivery mechanism for the city’s integrated health and wellbeing system as well as its aspirations for health and wellbeing set out in the Plymouth Plan. Thrive Plymouth draws on the approach to chronic disease prevention first presented by the Oxford Health Alliance.
Plymouth has three approaches
- Population-level prevention is about the whole population making positive changes, big or small, to their lifestyle choices. This is because lots of people with a small risk of getting a disease can cause just as much ill health as a small number of people with a large risk. So everyone making even a small change will help Plymouth Thrive.
- Common risk factor is based on the fact that one unhealthy behaviour can be the basis of many diseases, and that several of these unhealthy behaviours tend to cluster in individuals and in less affluent groups. Focusing on these common risks and how they cluster is more effective.
- Context of choice acknowledges that despite an understanding of what is unhealthy, and good intentions to be healthier, change is hard to achieve. This is because we all make choices in settings we often don’t control, where the healthy choice can be harder than the unhealthy one.
We want Plymouth to be a place where the healthy choice is always the easy choice.