Dr. William Polonsky, of the Behavioral Diabetes Institute, raised the concept ofattributional bias. When others don’t meet their goals, we tend to use personal factors or shortcomings, such as lack of motivation, as the explanation; when we don’t meet our own goals, we attribute it to situational factors like stress or limited time. Beyond contributing to the stigma of prediabetes, obesity, and type 2 diabetes, this bias leads us to focus prevention efforts on individual engagement and motivation, rather than environmental and social determinants of health. “The people who are going to solve the diabetes epidemic in America,” Dr. Polonsky said, “are going to be our urban designers.” While it may be an overstatement to expect just one sort of intervention to solve an epidemic, changes in our environment certainly encourage health without forcing people to make deliberate, active, and motivated decisions. Many others echoed the sentiment that the long-term solution can only lie in shifting social and environmental factors to the point where healthy decisions are the default, rather than the exception.
