Healthy Choices Don’t Happen in a Vacuum
We talk about health choices all the time.
Eat more vegetables. Move your body. Get enough sleep. Manage your stress. Take your medication. Make the appointment.
The advice may be perfectly reasonable.
But there is a question that often gets skipped:
What has to be true in someone's life for that choice to actually be possible?
I keep coming back to this question in my work because behavior never happens in isolation. We make choices inside homes, families, jobs, communities, schedules, budgets, cultures, relationships and bodies. All of those things affect what we have the capacity to do.
This isn't just a coaching observation.
Healthy People 2030, the federal government's framework for improving health and well-being in the United States, places significant emphasis on the social determinants of health—the conditions in the environments where people are born, live, learn, work, play, worship and age. It organizes those conditions into five areas: economic stability; education access and quality; health care access and quality; neighborhood and built environment; and social and community context. [1]
That matters because it changes the question.
Instead of only asking, Why isn't this person making the healthy choice?, we can also ask:
What is surrounding the choice?
Imagine someone has been told to eat differently.
Does she have access to the recommended foods? Can she afford them? Does she have time to prepare them? Is she feeding other people whose needs and preferences are different from hers? Does she understand the recommendation? Does it fit her culture? Is there enough physical and mental energy left at the end of her day to act on it?
Those aren't excuses around the behavior.
They are part of the behavior.
Healthy People 2030 makes this unusually explicit. Its own discussion of social determinants says that simply promoting healthy choices will not eliminate health disparities because the conditions around people also have to be addressed. One of its overarching goals is to create social, physical and economic environments that allow people to reach their potential for health and well-being. [1]
I think there is an important lesson here even at the individual level.
Knowing what to do and being able to do it are not the same thing.
That distinction is one reason I am so interested in capacity.
A person can be deeply motivated and still be short on time. She can understand exactly what her doctor recommends and still be caring for a parent, working full time and managing three other medical appointments. She can want to exercise and live somewhere where walking safely isn't easy. She can have a beautifully written SMART goal that makes complete sense on paper and falls apart the moment it meets Tuesday.
The goal may not be wrong.
The person may not be failing.
There may simply be information in the gap between the plan and real life.
Health is bigger than the absence of disease
There is another part of Healthy People 2030 that caught my attention.
Its framework explicitly includes physical, mental and social dimensions of health, and it tracks overall well-being alongside measures such as life expectancy and disability. Its measure of overall well-being is based on life satisfaction and recognizes that both health and non-health factors contribute to it. [2, 3]
That opens a much more interesting conversation about what supports health.
It doesn't mean every enjoyable activity becomes medicine. And Healthy People 2030 does not prescribe watercolor, creative coaching or art-making as one of its health objectives.
But it does give us room to think beyond the narrow idea that health happens only in a doctor's office, a gym or a kitchen.
That is where my other world—art—becomes interesting.
Research into programs often called Arts on Prescription or arts-based social prescribing is still developing. A 2024 systematic review and meta-analysis found improvement in well-being along with reported social and psychological benefits, while noting that some other outcomes still needed stronger evidence. A newer 2026 systematic review likewise found improvements in well-being across the included programs, but described the evidence for anxiety and depression as preliminary and called for more rigorous studies. [4, 5]
That distinction matters to me.
I don't need to claim that picking up a paintbrush cures anxiety, lowers your cholesterol or solves the conditions making change difficult.
That's not what I use art for.
Sometimes making something gives us another way to notice.
What am I carrying?
What keeps getting in the way?
What feels crowded?
What changed?
Where am I in this picture?
And sometimes seeing the answer on a page makes it easier to talk about what needs to happen next.
Maybe the better question isn't “Why can't I do this?”
When a health behavior isn't happening, our instinct is often to tighten the goal.
Make it more specific. Track it more carefully. Try harder. Find more motivation.
Sometimes that works.
But sometimes the useful work is farther upstream.
Maybe the grocery store is too far away. Maybe the schedule is impossible. Maybe support is missing. Maybe the plan belongs to someone else's idea of what health should look like. Maybe something that worked six months ago no longer fits the life you have today.
Those are different problems. They require different solutions.
And before we try to solve them, we have to be able to see them.
So perhaps the next time a healthy choice feels strangely difficult, the question isn't only:
What should I be doing?
Try adding:
What around me is making this easier or harder to do?
That isn't lowering the bar.
It's finally looking at the whole picture.
Art Prompt
Think of one healthy choice that feels harder than it seems like it “should” be.
Put a shape in the center of the page to represent that choice. Around it, add lines, colors, words or shapes for the things surrounding it—your time, energy, environment, responsibilities, support, resources, or anything else that affects what is possible.
Step back and look at the whole page.
What do you notice about what is surrounding the choice?
Sources
[1] Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. “Social Determinants of Health.”
https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health
[2] Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. “Healthy People 2030 Framework.”
https://odphp.health.gov/healthypeople/about/healthy-people-2030-framework
[3] Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. “Overall Health and Well-Being Measures.”
https://odphp.health.gov/healthypeople/objectives-and-data/overall-health-and-well-being-measures
[4] Jensen, A., Holt, N., Honda, S., & Bungay, H. (2024). The impact of arts on prescription on individual health and wellbeing: A systematic review with meta-analysis. Frontiers in Public Health, 12, 1412306.
https://doi.org/10.3389/fpubh.2024.1412306
[5] Sá, É. F., Monteiro-Soares, M., Ribas, M. J., Banzi, A., Henriques, J. S., Loureiro, D., Monteiro, L., & Baptista, S. (2026). Arts on prescription for wellbeing in adults: Systematic review. Frontiers in Public Health, 14, 1833798.