The King's Fund calls for more innovation in public health approaches that have tended to focus only information and communication campaigns (the 5% solution) or just offering financial incentives. The report summarizes the results of a year long study (pdf) of the effectiveness of various types of public health interventions that address smoking, alcohol abuse, obesity and physical inactivity. The conclusions of Kicking Bad Habits include:
The National Health Service (NHS) needs to make better use of social marketing techniques and data analysis tools like geodemographics to identify, target and effectively communicate messages and motivate people to change how they live.
Public health programmes shouldn’t rely on just one approach – such as information campaigns or financial incentives – as the evidence shows the most effective behaviour change interventions employ a variety of tactics.
A robust evaluation – of short- and long-term changes in behaviour and health outcomes – should be made a requirement of all public health programmes in order to build an evidence base for the future.
- Frontline staff should be more proactive in promoting healthy habits to the patients they see every day and for contracts and incentives to be used to encourage such behaviour.
- Government departments and local agencies involved in tackling unhealthy behaviours must better co-ordinate their efforts and ensure that targets are agreed to support their shared objectives.
My experience suggests that a similar study in the US would come to quite similar results. To fulfill the campaign promise of the Obama-Biden team to promote public health, they will need to look beyond their stated intentions to require coverage of preventive services, including cancer screenings, and increase state and local preparedness for terrorist attacks and natural disasters. The wicked problems of tobacco use, obesity, physical inactivity, increasing rates of childhood diabetes and other public health issues - not to mention many of the social issues facing the country - require innovations in how we think about influencing behaviors at the individual and systems levels. Why not a similar high level review and clear statement of what really works here - one that extends beyond HHS to include Education, Environment, Commerce, Housing, State and Treasury? And will they take advantage of the current work on developing Healthy People 2020 to bring change to public health priorities and practices in the next decade - not just domestically but in our global health efforts as well? I think it is time for a road map for public health promotion (not public health care) that is more than rhetorical priority and works in tandem with the health care activities that are already well underway during this transition time.