Tamira Snell is the Senior Advisor at Copenhagen Institute for Futures Studies. At CIFS Health Team, she focuses on health behaviour. Tamira has a background in cultural sociology, she investigates health behavioural patterns and cultural consequences of broader changes in global healthcare. This is the first part of her interview on interactions between culture and health behaviour. In this part, she elaborates upon the dynamics in health behavioural research with the advent of digital health technologies.
If you were to describe a relationship between health behaviour and culture to an outsider to these topics, how would you do it?
The way we perceive, experience, and behave around our health and wellbeing is fundamentally influenced and interlinked by the cultural contexts from which we make meaning. The values and norms that we share are culturally bound. However, they must not be perceived as being situated in an isolated space but as continuingly developing and in movement. As such the relationship between health behaviour and culture is complex, but understanding these dynamics are crucial to health and wellbeing futures.
First of all, a focus on understanding the intersections between society, culture and behaviour can help shed light over the norms and values we often perceive as being universal and take for granted. A greater understanding can thus help us rethink and reimaging possible health futures – in the light of potential changing norms and values. Second, we need to increase the awareness and insight into these interdependent dynamics to explore the interrelated determinants – and to assess potential drivers and barriers to change. Finally, this relationship is omnipresent, and therefore of importance to everyone. Health behaviour does not exist in an isolated space, but health is practiced and lived by all, inside as well as outside of the healthcare system. If we really understand the complex aspects moving in between health behaviour and culture, by default, it will have an impact on health equity.
Health behaviour has been a focus area for substantial research over time. What new do you see now in the behaviour related research? In what ways may these novelties effect our future?
In healthcare, the behaviour perspective has until recently often been focusing mainly on the individual in health behaviour – like measuring diet, activity, tobacco use, etc. However, applying the view of the ‘individual’ to health behaviour can sometimes be misleading as behaviour is so interdependent on cultural contexts and socioeconomic and environmental determinants, factors that stand outside of the individual. This acknowledgement has been leading a shift for quite some time. Lately, this already more complex comprehension is being supplemented by further perspectives on the health dynamics moving between social determinants and biosocial advances.
As a result, a social determinants approach acknowledges the interplay between biological and psychological processes as complex, dynamic systems, encompassing a population-based approach that places the individual in a broader context. Researchers are increasingly recognizing health behaviors as multidimensional and embedded in various layers of health lifestyles. These behaviors vary across the life course and within regions, reflecting a dialectic between structure and agency that necessitates situating individuals in their contexts. Measurements and models of health behaviors promise to improve representations of this complexity.
Future directions of health behaviors related to culture and various determinants will be guided by this foundational thinking. It will be a part of a holistic approach to health futures. The abundance of new data – from administrative data, personal and geographic data, over to social network, social media data, as well as medical and genomic data – will provide abundant opportunities for exploring possible futurescreative exploration. The scientific study of social determinants of health behaviors will continue to elaborate on this complexity and expand the boundaries of health behavior research.
We have been avid consumers of wearables and health apps. How do they affect our health behaviours?
It is true that the mHealth apps and wearables market has grown remarkably and is expected to continue. However, I think we also need to ask what the key drivers to this development have been before applying these insights to the effects on our health behaviours: there has been a rising adoption of smartphones together with an increase in their technological capabilities. Simultaneously we are witnessing a higher prioritization and awareness of personal health, or health literacy amongst users; an increased perceived value of mHealth apps by practitioners themselves, along with a need within the health system to develop patient engagement strategies.
Further, the integration of technology and seamless digital possibilities has increased overall in our everyday lives, influencing our behaviour generally, and not merely our health behaviours. The ways in which we use, live with, depend upon, and consume apps have had a great influence on our behaviour in all aspects of life. And we will continue to witness interesting developments. We live in a consumer culture. When we change what we buy, we change who we are. This has been evident also in relation to how wearables and health apps have driven both digital literacy, health literacy, a personalisation of health in the ways we get informed, motivated, and engaged.
These dynamics, including other greater socioeconomic and cultural currents, are creating an ongoing shift in our health behaviours that will continue. We are building our behavioural readiness in relation to our health behaviours. A growing challenge in relation to health futures and behaviours is growing polarisation and health equity. We will need to connect and facilitate the interoperability between, societal, technological, and behavioural readiness. And accept that there is no one size fits all.
UK’s Department of Health and Social Care and Office for Health Improvement and Disparities is currently launching a pilot with the vision to help people to eat better and exercise more. Participants will wear wrist-worn devices that can generate personalised health recommendations and will then be rewarded via an app with points for e.g., increasing their step count, which can be redeemed for gym passes and discounts. The initiative is thus scaled to population level as the polarisation, access and equity challenge is being recognised from a governmental and societal level as well.
However, also the cultural understanding will be of crucial importance here, in the exploration and understanding of various drivers and barriers to behavioural readiness, and finally change.