Why it is so hard to make people do more of something for their health, and how the Danes somehow managed it.

When it comes to our health, we are far more inclined to messages of restriction than we are to doing more of something. Sugar is poison. No carbs before Marbs. Go gluten-free. Don’t snack. Go vegan. Go keto. Go carnivore. Don’t touch anything with more than five ingredients. From unscrupulous online health gurus to flashy government sponsored health initiatives, encouraging people to cut stuff out is almost always the strategy of choice.

This is hardly surprising. From a policy and behaviour perspective, initiatives to stop people doing stuff have a reasonable track record. Efforts to lower smoking rates and reduce sugar consumption have been relatively successful over the past 30 years. Trans fats are barely consumed in many countries, with global bans hopefully not too far away.  And at an individual level, many people find restrictive diet rules relatively easy to follow, at least for a short time.

Encouraging people to do more of things is way harder. Eat vegetables, get some exercise, drink enough water, floss, have more sleep. All of these are potentially of benefit, but people rarely shift in a positive direction however often they are told. Eating 5 portions of fruit and vegetables a day is one of the most ubiquitous and well-recalled health messages, yet despite numerous initiatives around the world, very few people manage to achieve this relatively simple goal. In the UK, despite the 5-a-day message being consistently communicated for decades, only 25% of adults regularly achieve it, a figure which has hardly changed at all since the campaign was officially launched.

Why is it so hard? It may be that we are naturally inclined to avoidance behaviours when it comes to our health. As children, most of us are given a long list of stuff not to do to keep us safe (don’t go there, take that out your mouth, never run near the road, stop riding round on the dog), programming us to be more open to stopping stuff to prevent harm.

Also, new behaviours are often complex to learn, whereas following a simple rule (e.g. avoid sugar) can be far easier for us to take on. Eating more fibre, for instance, requires us to learn a bit about what fibre is, where you can find it, how much you need to eat, how much is in different foods, what different types of fibre do. People are busy and cognitive effort is a scarce resource, making them far more inclined to simple solutions.

There are very few examples of really successful public health campaigns where people were successfully encouraged to do more of something. One of the most remarkable is the Danish Wholegrain Partnership, an initiative focused on increasing wholegrain consumption in Denmark. So, why did this initiative work? And what can we learn from it.

The Wholegrain Partnership was a joined-up campaign to encourage wholegrain consumption involving government, health bodies, charities and the food industry. They created an easily recognisable wholegrain logo and put a lot of initial effort behind communicating that with the public. Crucially, food manufacturers and retainers got fully behind the campaign, launching hundreds of products that carried the new logo. Everyone moved at the same time, pushing a consistent, evidence-based message, and making it something that was easy for consumers to achieve.

Food manufacturers and retailers are always not well trusted, but they are very good at getting consumers to change their behaviour. Public health campaigners and academics are often very well trusted but are notoriously terrible at creating behaviour change. When these two sides come together, it turns out that remarkable things are possible.

In 2007 the average wholegrain consumption of a Danish adult was around 36g. The wholegrain partnership was established in 2008, and by 2019 consumption had increased to 82g, making Denmark the by far the highest consumers of wholegrains in Europe. Much of this was driven by product availability. Hundreds of products carrying the Wholegrain Partnership logo have been launched over the years of the partnership, making small changes achievable for almost all consumers.

The budget for the wholegrain partnership is only around $420,000 dollars a year, with just two fulltime staff and a handful of volunteers. Yet it is widely seen as one of the most impactful public health interventions of recent times, with many countries around the world attempting to mimic its success. It may turn out that some of that success is intrinsic to Danish character and cuisine preferences, but there must be something valuable to learn from such a hugely successful initiative.

The key lesson is probably a pretty straightforward one. If you want to create positive behaviour change, you need to make things simple. A recognisable logo, clear communication, consistent, joined up messaging. Add in some trusted voices from charities and health professionals.  All this can turn a complex positive behaviour shift into something simple and achievable. Perhaps most importantly, for real change to occur, the food industry needs to engage with governments, charities and health professionals, to help find ways of making better food for everyone.