Abstract
There are things known and there are things unknown, and in between are the doors of perception.
Most of us know we sit around too much, but what are our perceptions about how to change that? An Australian study quoted estimates of sitting 4–7 hours a day for office workers. 2 The majority of those surveyed identified poor health consequences but barriers to moving about more included social norms and lack of management support. Normative influences come up again in a survey of determinants of alcohol misuse among university students in Northern Ireland. 3 Despite high knowledge scores on alcohol health effects, respondents cited conflicts within the home, risk-taking behaviour and fearing social alienation as reasons for excessive alcohol use. Sensible drinking guidelines have proved insufficient to alter this: interventions could include a wider choice of recreational facilities, removal of alcohol advertising or sponsorship and a focus on educational messages before going to college.
Perceptions of smoking were examined in a US study of the impact of e-cigarette advertisements on adolescents. 4 Internet advertising and exposure in shops were most likely to influence use, while magazine and TV advertising had little apparent effect. Alcohol, smoking and poor diet all diminish oral health, which makes health promotion via community pharmacists a useful intervention. 5 About a quarter of English 5 year olds suffer from dental decay, with wide regional variation and a need for better coordination of oral health policies. School-age children also suffer from higher rates of functional gastrointestinal disorders and switching to a diet low in ‘FODMAPs’ (fermentable oligosaccharides, disaccharides, monosaccharides and polyols i.e. certain types of sugars) may reduce symptoms. 6 Such a diet needs to be carefully tailored and introduced or it will be perceived as too difficult to follow: food labelling and availability of products with low FODMAP could assist both uptake and research.
As for perceptions about breastfeeding, surveys show that 80% of new mothers start to breastfeed, while 85% stop after a few weeks. 7 This is due, in part, to social norms, as well as lack of support from families and healthcare staff. Resilience to social norms may be helped by improved mental wellbeing in adolescence and early adulthood, the peak age for onset of mental ill-health. In a literature review of the effect of creative activities, 8 positive factors included improved self-confidence and self-esteem, although the research methods need to be more stringent in this field.
Mental health problems are common in refugees and migrants: health and financial dilemmas from the European refugee crisis are highlighted in a report from Greece. 9 Over a million refugees and migrants arrived in Europe in 2015, with 85% landing on Greek islands and over half being women or minors. In addition to more international support for surgical and other healthcare, wage subsidies may encourage employers to give work to migrants. The doors of perception need considerable help to solve this political and humanitarian crisis, but meanwhile there is much in this issue of the journal to stimulate ideas for changing behaviours.