We want to get the nation fit and active, and to achieve this we must understand the environmental and social factors that reinforce certain behaviours at a subconscious level. We can’t simply give people information and expect them to change their behaviour.

This is the topline finding of a paper published in November by Dr Stanley Blue of Manchester University. Blue explains: “Smoking, exercise and eating are fundamentally social practices. Trying to get individuals to stop smoking or to eat healthily overlooks this fact.

“Public health policy will have to find the courage to break away from its traditional mould if it’s to stand a chance of confronting lifestyle disease. Current policy is dominated by the presumption that individuals are capable of making ‘better’ choices for themselves on the basis of information given to them by government or other agencies. This doesn’t account for the fact that practices like smoking and eating have histories of their own.

“We need to re-shape what is deemed socially acceptable and normal in order to change these practices.”

Research carried out by Ipsos MORI last year came to a similar conclusion. In the study, three-quarters of respondents underestimated the percentage of people in England who were meeting physical activity guidelines – and many saw this as an excuse to follow suit. “Our understanding of the social norm has a huge effect on how we act: if we think everyone else is doing it, we’re more likely to do it ourselves,” explains Bobby Duffy, MD of Ipsos MORI’s Social Research Institute. “People think the norm in society is inactivity.” (see p54)

So what can we do about this? Blue believes social practice should be placed at the heart of public health policy, with junk food, excessive consumption of alcohol and physical inactivity made socially unacceptable in much the same way as smoking has been. He also believes making the ‘right’ decision – going to the gym or eating five portions of fruit and veg a day, for example – shouldn’t be a matter of personal choice.

But that’s a tough call to make, as it implies a legislative approach – similar to the smoking ban – that forbids people from doing anything unhealthy. Quite aside from the authoritarian overtones that jar with the fabric of our society, we also need to be practical about this: how can we possibly legislate against people sitting down?

We need to turn this argument on its head. Making inactivity less socially acceptable would be no bad thing, but as behaviour change expert Dr Paul Chadwick says on p38, instilling a sense of shame can be counterproductive. If we’re going to legislate, let it be for activity rather than against inactivity: making leisure statutory, making active design a compulsory part of urban planning, and creating a national exercise incentive scheme. And at a club level, let’s learn from the likes of US yoga operation Brewasanas (see p60), which accepts that people enjoy a drink. We need to follow its example and bring that together with exercise into one social experience; if we make it either/or, the pub will win.

Kate Cracknell, editor

[email protected] @HealthClubKate