President's Message: Manifesting your Reality

Ellen Beckjord, PhD, MPH, FSBM, SBM President

“Manifesting your reality” shows up a lot in our information environment these days. In a recent article from Psychology Today, manifesting is noted as a “pop culture phenomenon,” but one that, when you dig into it, like most things, is a mixed bag of evidence-based behavior change techniques and plain old garbage (separately, I’m fascinated by this phenomenon of how bimodal the quality of content seems lately in virtual and real environments. As another example, in any grocery store, you can buy locally sourced organic produce that is stocked next to what is arguably poison (in the form of breakfast cereal which is. a topic for another day).

I’ve never been one much for manifesting my reality as a way to reach my goals or have the things I want. That may work well for some, but I’ve always preferred creating the conditions that increase the probability that I’ll reach my goals or have the things I want. Admittedly, that doesn’t roll off the tongue in the same way as The Law of Attraction (made popular by the manifesting manifesto The Secret) does, but you good folks of SBM get my meaning.

The conditions in which our behaviors occur represent context. And as I’ve written previously, context is multi-layered, starting with our internal cognitive and emotional states and venturing out to interpersonal, group, community, systems, and global levels. Earlier in my career, I was focused on affecting internal context to support health behavior change. I designed a just-in-time adaptive intervention (JITAI) to support smoking cessation, with the JITAIs designed to remind people of their motivations to quit smoking. Over the past few years, perhaps because of my professional move into executive leadership in the payer arm of an integrated delivery and financing health care system, I’m more interested in intervention at broader contextual levels. In more than 50 years of evidence-based smoking cessation intervention, including pharmacological interventions that change internal context at a biochemical level, our biggest gains in smoking reduction came after the cost of cigarettes dramatically increased and it became virtually impossible to smoke almost anywhere indoors. While individual level interventions do and will have an important role to play in improving health, interventions that affect broader levels of context – that affect the conditions that make targeted behaviors more or less probable – have a larger role to play in improving population health.

When it comes to our health we can, and should, as the adage says, “control the things we can.” Creating the conditions that allow for the behaviors we want to occur or that make less likely the behaviors we are trying to extinguish matters very much. I have a 15 year-old daughter. I have, and want to continue to have, an open and trusting relationship with her. At least once a week we have “tea time;” usually at about 8 pm, I make us each a cup of tea and then listen to the wall of words she produces for the next hour or so. I don’t have an agenda for what we talk about and I’m not targeting a specific conversation – I’m creating the conditions that allow for what I want, which is for my daughter to let me know her mind. It would probably work just as well with water or coffee, but for other parents out there, I have to say, somehow tea is like a truth serum for my teenager!

When it comes to healthy behaviors, so many contextual factors are working against us – conditions are not optimizing the probability of reaching the goals we’ve set or the outcomes we want. Most of our plenary sessions in San Francisco at SBM 2025 will speak to this, including ways the product environment, information environment, and health care system work against health. My hope is that these talks will lead to conversations about how we can design interventions that, at a minimum, account for ways contextual factors work against health, and, more ambitiously, transcend those conditions, or seek to change those conditions directly.

In the wake of the 2024 election, given changes in seats of political power, we can reasonably anticipate policy changes – an effective lever for changing context – that will affect health in several ways. Whether you are in favor of or against these likely changes, it’s important that we are aware of them and how they will interact with our individual and professional efforts to improve and/or maintain health. You’re not likely to win a game for which you don’t know the rules.

In the meantime, while the Annual Meeting is still several months ahead, it’s not too early to start creating the conditions that you want to have a wonderful conference experience! Look out in the weeks ahead for more information on plenary speakers and other presenters. Reach out to people whose work you admire and who you’d like to meet. Be proactive about the experiences you want to have in San Francisco, both inside and outside of the conference. If you’re like me, start planning your conference wardrobe (for years, I’ve been in a SBM fashion competition with Drs. Gary Bennett and Charles Jonassaint (I never win). And leave time and space for synchronicity – when almost 2,000 of us working to help people achieve better health through behavior change gather, inevitably, there’s some magic.