This paper is reformatted and reprinted as part of the 40th anniversary of the American Journal of Health Education (formerly School Health Review) Health Education--Our Heritage series. The original paper appeared in Volume 1 (September 1969, pp. 15-19). At that time, Godfrey M. Hochbaum was deputy director, Social Analysis and Evaluation Program, National Center for Health Services Research and Development, Health Services and Mental Administration, U. S. Public Health Services, Washington, D. C.
Before considering the need for changing health behavior, it may be useful to think about how we learn health behavior to begin with. This should help us to understand the reasons why it is often difficult to effect changes--and how we may succeed.
From the moment the infant is born, almost everything done for him is intended to protect him against harm and to promote his physical and mental development. The infant is helpless and vulnerable, and his health and safety depend entirely on what adults can do for him.
As he grows older, some of the responsibility for his own health, safety and welfare is gradually shifted to him. He is led to acquire certain health habits, such as keeping his body clean, not to play in the street, and so on. He begins to learn that if he does certain things they will cause pain either directly, as when he burns himself on a hot object, or through punishment from his parents, as when he is spanked for playing with matches. On the other hand, he reaps rewards for "good" behavior. He feels better when a wound is cleansed and dressed, or he is praised after brushing his teeth. Through such rewards and punishments, he learns to differentiate between desirable and undesirable behavior and acquires various habits and behavior patterns, even though at this young age he does not yet know and understand their implications for his health.
Which behaviors he learns to consider desirable depends, of course, on what his parents and other adults around him happen to know and believe--and this may not always be correct. But there are also other sources--the child has varied experiences with illness and with medical personnel, both of which influence his feeling and thinking about health. Perhaps even more important are the many bits and pieces he picks up from overhearing adult conversations, from the often distorted and misinformed stories he hears from other boys and girls, from watching TV programs and commercials, etc.
Out of all these diverse, often unreliable, and unrelated sources of health information, he forms ideas, attitudes and beliefs about health and illness before he is able to sort out the valid from the erroneous, and the reliable from the unreliable, and before he understands why some of the practices which he acquires are more important for his present and future health.
As he grows older, and especially once he goes to school, he is exposed to more systematic and reliable health information. He also becomes more capable of judging and deciding for himself. It may happen that what he now learns fits in well and reinforces already existing beliefs, attitudes and habits. Thus, if he now learns about the beneficial health effects of oral hygiene this may strengthen his long-established oral hygiene habits. It may, however, happen that what he now learns is different from what he has earlier come to think, believe, or do--in which case he has to choose between the new or the older ideas and habits.
The trouble is that many of these early established patterns of behavior and their underlying beliefs and views are by now deeply ingrained and often quite resistant to change, or at least to the complete change that would be suggested by his new knowledge. And so he carries with him both the old and the new, even though these may be fundamentally opposed to one another.
We then see that the school child has health information, attitudes, values and habits which are the product of multitudinous sources, influences and experiences. …