TCS Daily

Scare Tactics

By Jonathan Robison, PhD, MS - April 15, 2004 12:00 AM

Have you ever noticed that most discussions about our desire for health actually have more to do with our fear of disease? We talk about:

  • Exercising to prevent heart disease
  • Eating fruits and vegetables to prevent cancer
  • Quitting smoking to prevent -- just about everything bad

Messages from our health institutions and experts almost always focus on fear of disease and death as a means of motivating people to change their habits. Its always "don't do this" or "stop doing that" because it will kill you or because it will increase the likelihood of your getting this or that disease. Is this a good way of motivating people? More importantly, does it work?

Scared Stiff

Actually, if we look around us, there is very little evidence to suggest that fear is a very good motivator for long-term, health behavior change for most people. Think about it for a minute. If fear actually worked:

* Everyone would be exercising. You would really have to be living under a rock for some time in this country to have not heard how wonderful exercise is for warding off death and disease. Yet, the percentage of people exercising has not changed much in the last 20 years except for perhaps for children, who are exercising less.

* Everyone would certainly be thin. Could we possibly have scared people any more than we have about the risks of gaining weight? The battle of the bulge has been cited by many health organizations as the nation's number one health problem and the Surgeon General has claimed that obesity poses more of a threat to our welfare than do weapons of mass destruction. Yet, the population continues to get heavier.

* Everyone would be eating fruits and vegetables. Actually, this one is partially true -- although the vegetable that is being eaten the most is probably not one that was the intended target of the promotion -- French fries!

What is it about this fear-based approach that makes it ineffective? Judge for yourself. Here is an actual public service announcement from one of our major health organizations about preventing high blood pressure:

"It'll be a warm, sunny afternoon at the stadium. The skies are just screaming blue. The beer man is flying up and down the stairs. The crowd is wild cause everybody's favorite guy is up to bat, up to knock in his umpteenth career homer! The pitch comes; you hear a loud smack as that ball sails away, over that silly embarrassed pitcher, way over left field, high into the sky section, and look! It's headed right to your seat! You heard me, your seat! But you know what? You quit treating your high blood pressure, so you had a stroke and you're dead, and somebody else is there in your seat screaming and jumping and waving their glove and guess what...that bozo got your ball. Don't lose a minute of life. Exercise. Eat right. Cut the salt. Treat your high blood pressure. For more information call -"

What's going on here has been described by the noted health promotion expert Dr. Judd Allen. (1)

"It has been common practice to describe the disease which might result from a health risk behavior in order to frighten the client into changing...Unfortunately, this method has not led to the intended results, and has been linked to actual increases in the health risk behavior which was the target of the effort."

The bottom line question here may be this. Can we really help people to be healthier by scaring them to death? Unfortunately, in spite of the research and the lack of supporting evidence, this approach is the one most often embraced by our health education and promotion efforts.

The P-Word

Is there perhaps a more effective way to help motivate people to be healthier? How about focusing on pleasure and love of life as opposed to disease and fear of death? How about a goal of helping people to decide for themselves what it means to be healthy, rather than telling them what it means and prescribing for them what they ought to be doing? (Think of it as teaching them to fish rather than buying them a fish dinner) (2,3)

What if, instead of trying to frighten people into changing their behaviors to prevent death and disease, we suggested to people that they:

Exercise to connect with the joy of moving their bodies, to have more energy to participate in life, or to enjoy the solitude of nature or the company of a friend

Eat fruits and vegetables to provide variety, flavor, color, and important nutrients to help their bodies function and grow

Stop smoking cigarettes to save money, have cleaner houses and smell better 

There is a convincing body of evidence that suggests that chronic fear and anxiety can have devastating effects on our physiology. A growing number of experts have warned that fear-based health promotion efforts may end up doing more harm than good by creating an "epidemic of apprehension" (4) that transforms "persons at risk" into "anxious persons at risk" (5) resulting in a population best described as "the worried well." (6)

In their book Healthy Pleasures, Drs. David Sobel and Robert Ornstein explore the potential dangers of this climate of fear, and offer an alternative, pleasure-based approach to health, saying:

The point is that worrying too much about anything -- be it calories, salt, cancer, or cholesterol -- is bad for you, and that living optimistically, with pleasure, zest, and commitment, is good. Medical terrorism shouldn't attack life's pleasures. (7)

FDR Was Right

Traditional approaches to promoting health assume that left to their own devices people will self-destruct; sit around, watch TV, smoke, drink, never exercise, etc. However, there are always at least two ways of looking at everything. What if instead we promoted the belief that people actually want to be healthy, and that for the most part they are doing the best they can given their present environment and circumstances? What if we trusted that we all have the inner wisdom to figure out what is best for us, though sometimes we all need a little help? With this approach, the important questions to ask about our health behaviors shift from:

· Will this kill me if I do it?

· Will I get this disease if I don't do it?

· What will people think about me if I do or don't do it?

TO à

· How do I feel when I do it?

· Do I like feeling this way?

· How do I feel about other consequences connected with doing or not doing it?

Given the limited success of traditional, fear-based approaches to health behavior change, what have we got to lose? Anyway, didn't someone once say "the only thing we have to fear is fear itself?"


1. Allen, J., Allen, R. From Short Term Compliance to Long Term Freedom: Culture-Based Health Promotion by Health Professionals. American Journal of Health Promotion, Fall 1986;39-45.

2. Buchanan DR. An Ethic for Health Promotion: Rethinking The Sources Of Human Well-Being. New York: Oxford University Press 2000:154-170.

3. Greenberg JS. Iatrogenic Health Education Disease. Health Educ 1985;16(5):4-6.

4. Thomas L. An epidemic of apprehension. Discover1983;4:78-80.

5. Job, R. Effective and Ineffective use of fear in health promotion campaigns. American Journal of Public Health 1988;78:163-167. 1988

6. Barsky, A. The paradox of health. New England Journal of Medicine 1988;318:414-418.

7. Ornstein R, Sobel D. Healthy Pleasures. Reading Massachusetts: Addison-Wesley 1994.


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