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How can medicine compete against the new normal?

Joanna was exactly the person we are being urged to help. In her forties, overweight verging on obese. Hypertensive, asymptomatic but well on her way to chronic diseases. We discussed her diet.

I like salt. So my food tends to be salty. Also most people in my house are my size. I thought about reducing my portions but I like meat, lots of meat. I’m a member of a gym but I rarely go there.

We talked about her risk of heart disease and encouraged her to banish the salt cellar from the table, perhaps think again about reducing the portion size and making time to go to the gym. She looked at me pityingly her eyes said

Well that ain’t gonna happen

This was not a teachable moment. She was not ready to make an investment in changing her habits. She could not see that she was at risk. She was ‘normal’ as far as she could see. So she was not going to change her diet to deal with a problem that she did not perceive as real.

There are many things that are regarded as ‘normal’.

It is now normal:

  1. To have to wear extra large clothes.
  2. To be offered larger portion sizes when we dine out
  3. For more than one in three Australians aged 14 years and over to consume alcohol on a weekly basis
  4. For friends or acquaintances to be the most likely sources of alcohol for 12–17 year olds (45.4%), with parents being the second most likely source (29.3%)
  5. For more than one in three Australians aged 14 years and over to have used cannabis one or more times in their life
  6. For more one in ten people to drink and drive
  7. For one in three people to lose their virginity before the age of 16 ( i.e. before the age of consent) and also to have multiple partners
  8. For 66 percent of all men and 41 percent of women to view pornography at least once a month, and that an estimated 50 percent of internet traffic is sex-related.
  9. For most people who join a gym to never use it

These and many other trends dictate what is ‘normal’ to the average person. It’s OK to eat and drink far too much because everyone else does. It’s OK to be promiscuous, watch pornography and take risks because that’s what people see happening all around them.

Against these trends the challenge is to seek opportunities when ‘normal’ is seen as risky and hopefully before that risk has manifested as pathology.

Picture by Mario Antonio Pean Zapat


  1. Unfortunately my kids are there. I have changed and found that they are slowly taking my lead.

    Key to all of this is to understand that we have ignored the obvious because it makes money. Asvertising is for the consumption of stuff and the use of the auto.

    I ride my nine everywhere and ignor TV and Radio to stay away from the influence of advertising. My bicycle is a form of destination based exercise. I despise the gym as I do a lot of work and get no where. On a bike at least you get somewhere.

    As a healthcare provided ask yourself how many employees ride a bike? Do you even have bike parking at your clinic. Do you make it obvious there is a better way to get to an appointment,?

    Normal only chAngez when we step out and create it. P

  2. Thank you Thomas,
    I agree. We should model the behaviours we wish to promote. At the same time we need to be aware of these counter pressures as we attempt to draw people’s attention to the risks they are taking,

  3. ANDI sebastian says:

    I agree with Thomas. We need to change normal because many people are uncomfortable with it. Change Day Australia had pledges from over 77000 people this year, all of these in some way, initiating or deepening g change. Many of these addressed the issues you discuss. At one large metropolitan health service spread over several campuses, staff teams worked together to map bike, walking and public transport options for workers to use and improved facilities on arrival. Starting with ourselves in health impacts families, patients, their families etc

  4. Did you know that in the USA women’s clothing sizes changed so that someone who used to be a healthy size 8 or 10 are now size 5 or “petite” while women who used to wear size 12 or 14 are now wearing size 8 or 10. Their weight hasn’t changed! Only their dress size. So that the new normal is what used to be considered chunky

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