When launching Cancer Australia’s Cancer Lifestyle Check, Health Minister Sussan Ley said that it was “designed to motivate people to take simple, achievable steps to reduce their risk by assessing lifestyle factors, including weight and diet, physical activity, alcohol consumption, smoking and sun exposure.”
It sounds straightforward but how accurate are the claims being made by the Government and Cancer Australia about this online resource?
Given our current understanding of the impact of the social determinants of health, including pervasive factors such as poverty and racism, how accurate is it to categorise some cancer risks as ‘lifestyle factors’?.
Exactly how ‘simple and achievable’ are the recommended steps for people dealing with housing insecurity, poor access to fresh food, discrimination and low levels of education?
Professor Evelyne de Leeuw discusses these issues in more detail and gives the Lifestyle Check its own check, scoring it low on equity and information provision but high on profile-building for the Government.
Evelyne de Leeuw writes
With considerable fanfare Cancer Australia launched a website that allows us to do ‘lifestyle check’ so that one-third of all cancers can be prevented. I instantly jumped at the opportunity to get some suggestions to engage with the threats that affect some more than others.
One-third of cancers can be prevented! Through lifestyle change! In itself a debatable assertion. Yes, for some cancers there is a strong association between behaviour and disease – think of lung cancer and melanoma. But for many cancer types the causation mechanism is mysterious, complex, tentative, or merely statistically relevant.
To suggest that a website would allow a ‘lifestyle check’ to prevent cancer is, certainly at the individual level, not a claim that can be wholly substantiated.
Also, by not acknowledging other environmental causes of cancer causation, and recognising that ‘lifestyle choice’ is to no small extent determined by social, economic and political context, this website in fact may have seriously adverse effects.
The inverse care law
Highly health literate people may interpret and use the technology on the ‘lifestyle check’ in considerate and balanced ways. But the evidence is out there that, in fact, they already know very well what would be healthy lifestyle choices. The inverse care law applies: those who need it most get it least…
Indeed – recent research suggests that the majority of people in our society has appropriate knowledge about healthy eating, drinking, sex, sun exposure, etc., but does not feel enabled (either through social norms in their particular population group; or something that is called ‘self-efficacy’ – the ideas you have about your potential to change; or access to healthy products) to act on that knowledge.
Such ‘disempowerment’ is mostly found at the lower end of the social gradient.
A comprehensive policy and program package?
The lifestyle check is not very helpful in addressing these issues. In general, the internet is no better (and possibly a worse) health behaviour intervention platform than more traditional media – and can only be considered effective in combination with targeted, tailored packages of policy, organisational and communicative actions.
From the website of Cancer Australia I do not get the impression that such an integrated multi-level intervention programme that is firmly grounded in a comprehensive understanding of the social determinants of health and carcinogenesis is anywhere near the policy radar of the organisation.
But maybe this Lifestyle Check isn’t really intended to reduce health inequities in cancer prevalence and mortality! Let’s see what other reasons there may be for the glorious launch of a slick looking website.
a. ‘We’re here, we care’
Many government initiatives need to make an effort to stay on the social and policy radar. A launch of something interesting is a way to secure that visibility (it is tempting to refer to various episodes of the ABC comedy Hollow Men where ‘a launch’ is suggested as an eminent tool to profile politicians – but let’s not be that cynical). Considering the attention the launch has received on social media it is now clear that Cancer Australia exists, and is doing good things.
A green smiley can be awarded!
b. Inform people of risk & help them stay healthy
There is a belief that an ‘interactive’ website would contribute to people’s risk assessment and would motivate healthier lifestyles. At a very basic level, this is not what the Lifestyle Check accomplishes. It is only by the application of pre-existing knowledge about the determinants of health that someone engaging in this risk assessment exercise may be able to interpret risk and behaviour change appropriately.
The feedback that the Lifestyle Check is not personalized and tailored to the particular needs and contexts of the interested Lifestyle Checker – it provides mere standard advice that it would be good to reconsider certain behaviours, and does not acknowledge how problematic it might be for some to follow that advice.
Unfortunately we have to give a red frowney here!
c. Invest in the health and health equity of all Australians
Cancer Australia proudly reports to have knowledge and capacity in population health and health promotion on its website. I assume that the experts in this field consider the Lifestyle Check as a work in progress.
Good health interventions are theory-based and grounded in evidence on the effectiveness and synergy of intervention packages (thus, including organisational, communicative and policy change). In the country where the ‘fair go’ was invented and we actually have an NHMRC Centre of Research Excellency for Social Determinants of Health Equity one would assume that good intentions in health promotion are internationally benchmarked against best practice and best evidence.
A poor track record
In that very space, web based health advice does not have a solid track record in the ability to reduce the gap in health inequities. Only intelligently curated, moderated, bespoke, and packaged information technology and social media use may have effects to improve health and reduce health inequity.
Regrettably, none of these attributes can be found in the Cancer Lifestyle Check. On the other hand – why wouldn’t the health promotion experts of Cancer Australia apply some rigorous Intervention Mapping development and testing to accomplish such an approach? This could be a start for something bigger and deserving of more fanfare!
Evelyne de Leeuw works at the Centre for Health Equity Training Research and Evaluation and is the author (with Carole Clavier) of Health Promotion and the Policy Process, a launchpad for renewed substantive investment in health, policy, and politics.