The Disconnect at the Heart of Preventative Health

Working one-to-one with people for over fifteen years, I've come to appreciate what it really takes to create meaningful behaviour change and support someone in making healthful, wellbeing-aligned choices on a consistent basis.

There is now a wealth of research, particularly within the self-improvement and psychology fields, dedicated to understanding how people make decisions and, therefore, how lasting behavioural change occurs. One of my favourite concepts is the identity-based behaviour change model.

To give you a whistle-stop tour, this model describes four stages that people move through, often at different speeds. Essentially, it's a progression from thinking to becoming, and it's only by reaching the fourth stage that meaningful, lasting behaviour change tends to occur.

Let's use the example of reducing sugar consumption.

Stage 1 – Mental:"I think I should stop eating so much sugar. I know it's not good for me."

At this stage there is knowledge and intention, but nothing has actually changed.

Stage 2 – Emotional:"I'm starting to notice how sugar makes me feel. I crash in the afternoon, I'm gaining weight, my skin is worse, and I don't like how I feel."

Now the issue becomes emotionally meaningful. Change starts to matter personally rather than intellectually.

Stage 3 – Behavioural:"I'm going to stop buying chocolate, cut out fizzy drinks and avoid desserts."

This sounds promising, and the person may genuinely begin changing their behaviour. However, it's often driven by effort and willpower, making this stage surprisingly fragile. It relies on constant self-control, which inevitably becomes more difficult after a stressful day, a poor night's sleep or simply when life gets in the way.

Stage 4 – Identity:"I'm simply not someone who eats a lot of sugar anymore. I choose foods that nourish me."

Here, the behaviour is no longer something they're trying to do. It's an expression of who they believe they are. The decision becomes easier because it aligns with their identity.

The first three stages rely, to varying degrees, on motivation. The fourth relies on identity. I believe this is why it is so much more sustainable.

This insight into behaviour change is crucial because it explains why people can have the very best intentions, only to find themselves back where they started a few weeks or months later. This isn't because they didn't care enough, lacked knowledge or weren't intelligent.

In fact, when it comes to basic health and nutrition, most people already know what they should be doing. They know fruit is healthier than sweets. They know vegetables are healthier than chips. They know being active is better than being sedentary. If information alone changed behaviour, we simply wouldn't be facing today's levels of chronic disease.

What surprises me is the disconnect between what I, and many other doctors, therapists and coaches, have observed through years of practice, and the way many preventative health strategies continue to be designed.

For decades we've communicated health through statistics, disease risk and fear-inducing future outcomes. While some of these messages may have their place, I rarely see them create lasting transformation. They may create concern, but concern isn't the same as change.

Then comes perhaps the most celebrated strategy of all, willpower.

People decide this time will be different. They become disciplined, motivated and determined. For a while everything goes well, until life happens. Work becomes stressful. Children become unwell. Relationships become challenging. Energy drops. Before long, familiar behaviours quietly return.

I don't see this as a failure of character. It's a very human response to life's pressures. If anything, I think we've misunderstood how lasting behaviour change actually happens, particularly in a world where chronic stress has become so commonplace.

To me, we simply cannot afford to leave this understanding of behaviour change out of preventative health.

Education, awareness and information all have value, but they are not where behaviour change begins. Behaviour doesn't emerge in isolation. It grows from beliefs, emotions, repeated experiences and the environments that quietly shape how we see ourselves every single day.

Identity doesn't emerge in isolation either. It takes far more than a leaflet, a campaign or a single conversation with a healthcare professional. Identity is cultivated over time through stories, the people around us, the environments we spend time in and the messages we receive every day. It is shaped by what is celebrated, what is rewarded and what becomes normal. Think about the extent to which sugary drinks continue to be associated with elite sport and athletic success. Those associations quietly influence identity far more than we often acknowledge.

Imagine if preventative health was designed with this understanding at its core.

Imagine creating daily environments that consistently reinforced health, resilience and wellbeing. Imagine sporting events becoming opportunities to celebrate the choices athletes make to perform at their highest level, rather than simply another platform for products that undermine long-term health.

Imagine workplaces that celebrated sustainable energy rather than chronic busyness. Schools that celebrated self-care and lifelong health skills alongside academic achievement. Communities where healthy living wasn't something people were trying to do, but simply part of who they believed themselves to be.

We've spent decades trying to scare people into behaving differently, or trying to convince them their choices are inappropriate, when what we need to do is create environments where people feel valued and supported, see themselves as a priority, and be inspired to make choices that align with an identity rooted in feeling good about themselves.

In all the years I've worked with people, I've never seen lasting behaviour change achieved with information alone.  We have to inject this wisdom and understanding of identity-based behavioural change into preventative health strategies for them to have a chance of achieving their intended outcomes, which today we need more than ever.

About the author

Dr Laura Holland is an advisor in preventative health and human capability, with a background in economics, nutrition and integrative medicine. Through BeU, she works privately with individuals, advises organisations, and writes about the future of health, behaviour and human flourishing.