I’ve recently heard something like “most medical advice is obvious,” and it got me thinking. Yes, if you think about it, most recommendations for prevention are quite straightforward.
We intuitively realize we must eat nourishing food, move our bodies, and get good sleep.
We intuitively realize we must eat nourishing food, move our bodies, and get good sleep.
But what really happens on the road between those obvious interventions and actual behavior change?
“Sleep medicine is behavioral,” Dr. rer. nat. Albrecht Vorster told us during a recent visit at the Sleep Clinic in Bern, “…but so is most medicine.”
I've been thinking about this for a while today.
A few thoughts came to my mind:
“Sleep medicine is behavioral,” Dr. rer. nat. Albrecht Vorster told us during a recent visit at the Sleep Clinic in Bern, “…but so is most medicine.”
I've been thinking about this for a while today.
A few thoughts came to my mind:
. Environment, resources, and unique context
When talking about behavioral change in prevention, the interventions really need to match the person’s schedule, lifestyle, geography, and unique environment and context.
For example, if you are a person who lives in a small city where you don’t have access to a gym, it will be more difficult for you to do weight training vs. someone who lives near an Equinox, for example.
Or if you're a new parent or caregiver requiring constant daytime alertness, maintaining a regular workout schedule becomes significantly more difficult.
Or if you simply don’t have proper infrastructure (e.g., you live near a train station) to help you maintain a weekly running practice, you simply won’t do it.
2. Individual resources and personal capacity
Another thing, closely related to the first one, refers to the individual capacity, preference, and already ingrained behavior of a person.
Some people might prioritize cooking and eating at home due to their genuine love for it, while treating sleep as non-essential.
Others might choose to eat out or order office meals, using the time they save on fitness training after work.
3. Behavior change is an individual pattern adjustment
For example, I used to have a gym subscription and also enjoyed running at least once a week, but during a particularly difficult context in my life, I left these habits behind. I was so tired and preoccupied that I could not find the slightest time for movement. At the same time, I didn’t really have decision-making energy, because I was mostly running on autopilot.
Something else to consider is that if your work life is draining you, finding the willpower to hit the gym afterwards would require a huge amount of energy. So maybe you could try changing your workout approach—maybe home-based yoga would work better for you. Also, recognizing that willpower is finite - if your work is draining, evening habits need to be nearly effortless.
Another example might be someone who struggles with sleep—if they invested in a new mattress to replace an uncomfortable one or transformed their bedroom into a more inviting space, would they begin to view sleep as a worthwhile indulgence?
Or do you think a person who has awakened at 5:00 am every day of their life easily adjusts to sleeping until 11:00 am? (see our parents or grandparents.)
Which brings me to the next topic, which is generational patterns.
4. Generational patterns
We live in a time deeply marked by the digital environment, which has disrupted our circadian rhythms and our sleep patterns.
Our parents and grandparents could just fall asleep, while we are scrolling TikTok at 1:00 am and living on pure caffeine and anxiety.
“We used to gather at the dinner table and have these meal rituals with our elders,” remarked Dr.Vorster during our visit, and I do have warm memories of cozy lunches and dinners with my grandparents, yet I'm struck by how different things are now—we hardly find time to eat properly, always rushing from one emergency to the next deadline or meeting.
5. Identity-based motivation
I recently read somewhere the observation that "phone screens are for our generation what TV was for our parents," and while it rang true, it left me deeply unsettled. This discomfort made sense when I discovered the psychological principle behind it: we experience internal tension when our behaviors contradict our self-image.
Research shows that behavioral changes happen when we anchor them to identity rather than outcomes. The most effective approach isn't setting goals like "I want to stop scrolling," but rather adopting identity statements: "I'm someone who prioritizes my mental clarity" or "I'm not the type of person who mindlessly consumes content."
This identity-based approach works because it leverages our fundamental need for psychological consistency. When we see ourselves as someone who values sleep, staying up scrolling creates cognitive dissonance that naturally motivates change. Instead of relying on willpower to achieve external goals, we're simply acting in alignment with who we believe ourselves to be.
The shift from goal-oriented thinking ("I should spend less time on my phone") to identity-based thinking ("I'm someone who is intentional with my attention") transforms the behavior from something we're forcing ourselves to do into something that feels self-respectful.
6. Accountability Through Love
Another thing that is really powerful in behavioral change is the science of social motivation, particularly accountability through friendship and love. It creates natural built-in rewards (connection, pride, shared joy).
This is why Duolingo shows your friends’ progress, nudging you to catch up, or Nike wants you to run in pair with a friend. You're not just learning Spanish, you're maintaining your reputation as "someone who follows through." And running with a friend transforms exercise from a willpower-dependent activity to a social commitment. Peer accountability shifts the cost from "I'm disappointing myself" (easy to rationalize) to "I'm disappointing someone who matters to me" (much harder to ignore).
There’s also the science of mirror neurons and behavioral contagion, where we unconsciously mimic people we're close to. When someone you love models good habits, your brain naturally wants to sync up with them.
Something else that I noticed in the apps I use and that seemed powerful was Aavia’s Partner Sharing feature. With this, Aavia texts your partner, bestie, or loved one with tips to support you during your difficult cycle phases. (feature available only in the US for now).
Having someone witness your efforts/struggle makes the struggle feel less isolating, and their encouragement literally regulates your stress response.
7. Aspirational community belonging
If your friend group does Sunday meal prep together, it becomes social and fun rather than a chore; but if everyone in your circle orders DoorDash, home cooking feels off.
I've seen a lot of my friends, increasingly being part of wellness clubs. Running clubs in San Francisco, running clubs in Barcelona, communal sauna clubs in Paris.
This is the actually the intersection of wellness trends, social belonging, and what I'd call "aspirational community building.”
As traditional community spaces (churches, neighborhood bars, local clubs) decline, wellness activities fill that social void.
They provide structured ways to meet people with shared values in increasingly atomized cities. Unlike gyms where people stay isolated, these are explicitly communal.
Seeing friends posting from running clubs or sauna sessions creates social proof that this is "what people like me do". Plus, it taps into the fear of missing out on both the health benefits and the social connections. And the Instagram-ability of these activities make them self-reinforcing.
This works for behavior change because you're not actually forcing yourself to exercise, you're hanging out with friends. It creates social accountability without feeling like pressure, and it makes the activity about identity and belonging, not just health outcomes.
Wellness becomes the vehicle for what people really want: community, identity, and social connection.
8. How behavior is shaped by cultural norms and cultural phenomena
If we were to look at the historical context - for example in the 70’s and 80’s - smoking rates were around 40-45% of US adults (vs ~12% today). Smoking was associated with coolness, rebellion, success - think about the Mad Men series with all those executives smoking in meetings.
Then aerobics classes and gym culture explosion in the 80’s and 90’s - fitness became aspirational middle-class identity. Then the tanning culture- it signaled wealth and leisure time (now it signals skin damage risk). Then the diet cycles.
Now trending among high performers (longevity enthusiasts, tech CEOs) is sleep optimization. Or the meditation practice - which went from hippie practice to corporate wellness tool.
9. Individual "motivation" is largely cultural programming
Which leads me to conclude this: we think we're making personal choices, but we're mostly conforming to or rebelling against our tribal norms.
The hustle culture sleep problem - "Sleep when you're dead" mentality peaked with tech/startup culture. But now, a new era of longevity start-ups reframed sleep as performance optimization. Elite athletes and CEOs talking about their sleep protocols let people maintain their achievement-oriented identity, while actually taking care of themselves.
I think it’s absurd to justify one of our basic human needs - sleep - as “performance optimization” and this only plays onto our capitalistic ethos. In a productivity obsessed culture, pure rest feels selfish, a rebelious act. But apparently, in this culture, without reframing it as "performance optimization," it gets deprioritized.
The irony is that the same generation that created the problem (24/7 digital hustle) is now creating the solution by making good sleep trendy. Sleep tracking apps, fancy sleep tech, "sleep hygiene" becoming as discussed as workout routines.
(…)
In the end, what matters is not just what fits you, or what fits the culture you are a part of. It matters to recognize that health (and prevention) is not just individual; or purely reliant on you and YOUR behaviour.
It is deeply connected with societal trends, norms, structures. And yes, it’s also political.
10. It’s also important to remember that health is fundamentally structural and political, not just personal.
The most successful health interventions work on changing the environment and systems, not just individual willpower.
Prevention isn't solely an individual responsibility - it's deeply embedded in our environmental and social systems.
We must recognize that when we frame health outcomes as purely individual choices, we ignore the powerful role of structural factors: urban design that discourages walking, work cultures that normalize sleep deprivation, food systems that make processed options more accessible than fresh ingredients, or technology designed to be addictive.
This individual-focused approach doesn't just fail - it's harmful. It places the burden of overcoming systemically created problems entirely on the person, leading to shame and self-blame when they struggle against forces much larger than themselves.
Someone trying to eat healthily in a food desert, maintain work-life boundaries in a hustle-culture workplace, or get quality sleep while juggling multiple jobs isn't experiencing a willpower deficit - they're navigating structural challenges.
True prevention requires acknowledging that personal agency operates within constraints. The most successful interventions work by changing the environment to make healthy choices easier, more accessible, and socially supported, rather than asking individuals to heroically resist systems designed to undermine their wellbeing.
This systems thinking shifts the conversation from "Why can't you just do better?" to "How can we create conditions where better choices become natural choices?"
True healthcare prevention functions only in alignment with environmental justice, agricultural reform, transportation infrastructure, technology regulation, and, of course, economic reform.
Healthcare prevention is fundamentally a policy issue, as well as a privilege.
Living wages that allow people time and resources for health-promoting behaviors. Housing policies that ensure stable, safe living conditions (housing instability directly impacts health outcomes).
Clean water and air as guaranteed public goods, not market commodities.
Stricter regulation of endocrine disruptors and neurotoxins.
Work regulations that limit excessive hours and mandate paid sick leave.
Policies that reduce car dependency and the associated sedentary lifestyle.
Why Public Health Avoids This:
It’s certainly easier to fund education campaigns than to confront powerful industries and economic interests, such as those in the food and chemical sectors, that might be disrupted by these changes.
Still, acknowledging that health is shaped by the conditions in which people are born, grow, live, work, and age—rather than by isolated individual choices—is the first step toward driving meaningful change.