The twentieth century has seen a dramatic reduction in the
threat posed by infectious diseases. Today, the biggest threat to
public health is harmful lifestyle behaviors.
``The heaviest burden of illness today is due to chronic
diseases that are, to a large degree, preventable,'' said lead
study author C. Tracy Orleans, of the Robert Wood Johnson
Foundation in Princeton, N.J. (www.rwjf.org).
Research findings appear in the December issue of American
Journal of Health Promotion (www.healthpromotionjournal.com).
Illnesses linked to lifestyle behaviors _ estimated to be
responsible for 70 percent of all medical care spending _ involve
tobacco use, alcohol and drug abuse, lack of healthy diet and
exercise, and risky sexual practices.
Still, while improvements are needed, Orleans expressed overall
optimism about the state of education and preventive health care
over the past 20 to 30 years, citing a huge decline in adult
smoking rates, an increase in seatbelt use, reductions in alcohol
use and driving, and more widespread use of condoms.
Evidence shows that modification efforts directed toward these
lifestyle behaviors can be effective in improving health.
Researchers examined the efficacy of these efforts directed at the
individual level, the community level and as public policy.
The most effective way to improve public health care, according
to the authors, is a three-tiered approach.
Methods that address individuals work, but only for highly
motivated people. Still, the authors said they hoped that the study
findings would raise awareness among individuals to take more
responsibility for their own health.
Health programs initiated in work environments, health clinics,
hospitals and schools could be improved with more individual
tailoring.
The public health approach was found to be least effective when
tried alone. However, the authors found strong evidence that a
``full court press'' combination of public policy with other types
of interventions works best. The result of this kind of effort has
been successful in tobacco and alcohol behavior modification. An
example is the combination of ``no smoking'' policies in the
workplace and an increase in taxes on cigarettes.
One challenge to health care intervention is doctors' lack of
time. Doctors spend about 15 minutes per patient visit _ often not
enough time for a discussion on lifestyle behaviors and preventive
care.
Orleans emphasized that health care professionals will need to
``be creative in looking at the best channels'' to reach the
public, especially children, adolescents and those with high-risk
lifestyle behaviors.
Orleans said she and her team hoped that research results would
lead to improved intervention and educational supports _ in the
community and through public policy _ for individuals.
Although Orleans cited ``terrific progress'' in the field of
medicine over the last 20 years, ``we need to start working across
the sectors,'' she concluded: ``We still have much work to do to
improve the efficacy and reach of health behavior change programs
and strategies.''
