Social norms and their relationship to sustainable health behaviors

The relevance of social norms  

The 21st century is characterized by complex, pressing problems such as climate-driven changes in the natural and social environment and persisting health inequalities, which require collective action. Collective action necessitates cooperation between groups and large shifts in shared norms and behaviors carried by the majority.    

Social norms are informal, unwritten  behavioral “rules” that are shared and enforced by a social group. Descriptive norms refer to the predominant behaviors within a group (what other people do), while injunctive norms refer to behaviors that are accepted or rejected within a given group (what other people think you ought do). (Figure 1).(2,3)

Throughout history changing social norms have led to large behavioral changes, for example a smoking ban for public places has led to a steep reduction in smoking and strong disapproval of smoking in public.(2) Changing fertility norms (i.e. increased maternal age of first child) and recent social distancing as response to the COVID-19 pandemic are other examples of large-scale behavioral shifts initiated by policy incentives and/or norm shifts.(2)      

However, while policy incentives can help catalyze large-scale norm shifts, (1) these incentives are likely to impact specific groups first and might reinforce existing inequalities if they are not aligned with and beneficial to various groups. With the abovementioned projects we aim to describe the “current state” of social norms in the Netherlands, how this varies across sub-groups, and see if and how these norms impact the spread of sustainable health behaviors among different geographic and social groups. The derived knowledge will provide valuable evidence on the usefulness of context-specific policy incentives, such as subsidies, taxes, bans or information campaigns, to initiate behavioral changes.             

What are we going to study with LISS?

For the LISS consortium panel grant, the focus will be on meat consumption and transport behavior, since these two behaviors are:
(i) affected by changing macro-conditions and susceptible to societal reforms
(ii) likely to be (partly) shaped by social norms
(iii) are at risk to increase inequalities
(iv) but also have the opportunity to co-benefit health and the environment.

A recent report in the Lancet Public Health urges to include active transportation in the physical activity guidelines as means to benefit both health and the environment.(5) The recent increase in food prices or changes in policy incentives such as the proposed carbon taxes are other examples that show the timeliness of these measures. On March 14, 2023 a policy advice drawn by various ministries at the request of the government advised to increase taxes on meat products, dairy and long-distance flights in in order to be able to meet the climate goals. (9)  By fielding our questionnaire in March 2023 and 2024 we might be able to capture part of the impact of these potential measures on changing norms and corresponding health behaviors.

Changing prices and policy incentives might affect the behavior of groups differently not only because of financial circumstances, but also due to varying social rules and resulting differences in accepted health behaviors. Individuals living in neighborhoods with a variety of vegan restaurants and car-free roads are affected differently by carbon or meat taxes compared to individuals living at the outskirts of a city. Careful consideration of the context and social acceptability of promoted behaviors is important to avoid growing inequality and discontent with the proposed measures, as seen in France with the yellow vests (6), in order to safeguard a fair transition.

And what about Lifelines?        

For the Lifelines cohort grant the focus will be more on the geographical distribution of local descriptive norms regarding alcohol consumption, smoking and diet. Do they differ across regions and neighborhoods, and does this impact the probability to maintain or change a healthy behavior? This study also touches on the widely discussed topic of political polarization and discontent: rules and regulations initiated by  the national government are not always accepted in other regions of the country.(7) Despite years of efforts to reduce health inequalities, lifestyle behaviors such as smoking and alcohol use are still common in certain areas, while other areas show strong declining trends in these behaviors. If norms regarding certain behaviors differ across areas, one could expect that support for certain policies will also vary, and this has implications for the effectiveness of public health interventions. For example: the acceptance of COVID-19 vaccines strongly varied across social areas and was strongly correlated to political orientation.(8) Hence studying the influence of local descriptive norms and political discontent will give insight on potential resistance to social norms change – and could provide us with ways to identify opportunities for positive and equitable social change.