Parallel Session 1.1

Addressing the behavioural determinants of NCDs: empowering or victim-blaming?

Background :

It is emphasized from the outset that the multiplicity of inter-dependent determinants of NCDs need to be considered and addressed together as part of a comprehensive framework. This session, however, will focus on the behavioural determinants of NCDs, which encompass individual lifestyle factors, and the promotion of health and nutrition literacy and behavior change communication. Four major risk factors, which are primarily behavioural at the level of the individual: tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets. NCDs impose a disproportionate burden that on poorer populations in upper income countries and across all populations in low and middle income countries. Given the evidence of greater impact of the behavioural determinants on populations with low socio-economic status, these groups require greater focus and appropriately tailored approaches. Another strand of narrative that has dominated the discourse is that NCDs are primarily caused by poor individual choices on lifestyles, and that the strategy to prevent them is focused primarily on promoting healthy lifestyles, placing the onus (or blame) on the individual. This narrative still holds sway in certain contexts and among certain stakeholders – for example, in case of Governments which choose or are influenced to avoid addressing the wider socio-cultural, commercial and policy determinants, or among private sector stakeholders and the researchers they fund, which have vested interests in preventing those wider determinants from being addressed. 

Health literacy refers, broadly, to the ability of individuals to “gain access to, understand and use information in ways which promote and maintain good health” for themselves, their families and their communities. Despite the proliferation of health information on the Internet, there is a lack of evidence-based information that is easily available to the general public. Health and nutrition literacy is particularly important in order to prevent and control NCDs and their shared risk factors. For example, people with higher levels of health literacy are far more able to understand available nutrition information and to be empowered to make healthier choices, thus preventing both undernutrition and overweight and associated chronic NCDs. 

Social and behavior change communication is one of the health promotion strategies to modify the behavioural risk factors through the life course and improve health and nutrition literacy.  It should be considered one strategy among a comprehensive package which includes the legislative and policy measures addressed in other parallel sessions of the conference. It should be based on a thorough analysis of the epidemiological situation in each country by identifying the distribution of risk factors among different population groups and developing a national risk profile. Analysis of the social norms, socio-economic factors and motivators that influence individual behaviours should also be assessed, as well as the channels and communication approaches that are most likely to be accessed and successful among different groups. It should also assess the relative importance to different groups – including children and adolescents – of prevailing marketing of unhealthy foods and beverages, tobacco and alcohol as other measures such as front of pack labelling and fiscal policies. 

The session will emphasize the critical importance of starting early with health promotion interventions  - during pregnancy, in early childhood and in adolescence  - to create positive health and nutrition behaviours. It will discuss the evidence of the impact of early intervention on later NCDs.

Another health promotion strategy showing promise is so-called “nudges” to encourage people to make healthy choices, be more active, and eat better, among others.  Health promotion entails not just communication but also changes in the health sector itself and collaboration with other sectors, particularly education. “Healthy Cities”, “Healthy Workplaces”, and “Healthy Schools” are applications of the health promotion approach. This session will summarize the evidence on behavioural determinants and various approaches to modify them, including creating space for debate between behaviourist proponents of a principally health education approach to preventing NCDs and those who highlight the lack of evidence of significant impact of health education/communication interventions. It will showcase examples of best practices, innovations  and success from countries in modifying NCD-related behaviours across the life course as well as failed strategies, and will identify knowledge gaps for further research and suggest recommendations going forward.


Objectives :

  • To examine the current state of evidence on various behavioural determinants of NCDs in different contexts
  • To explore the evidence on strategies to address various behavioural determinants: what works, what does not work, and why; plus suggestions for national strategies 
  • To discuss examples of national strategies to address behavioural determinants, particularly from LMICs
  • To undertake a debate between i) a proponent of behavioural interventions and ii) the counter view, with recommendations for a way forward
  • To analyze the political economy of “promoting healthy lifestyles”. 
  • To identify knowledge gaps and research priorities