Reducing Disease Burden:  Engaging the Public

Georges C. Benjamin, M.D., F.A.C.P.
Executive Director
American Public Health Association

This year’s annual America’s Health Rankings continues to provide information about important trends in our quest to improve individual and community health.  While we continue to see some improvements, we also continue to see to see a disturbing erosion of the remarkable progress our nation had been making in the rate of these improvements.  The report’s findings show that preventable disease continues to occur at disturbing rates despite clear evidence that improved outcomes could be achieved by improving individual health through behavioral changes and by population based measures that provide broad health protections.  These changes require a more engaged public -- a public that makes prevention a priority.  Unfortunately, even though public health measures have been responsible for the greatest increase in the human life span over the last decade, and 74 percent of Americans reported that they and their communities both benefit from public health per a recent survey by the American Public Health Association and Research!America,  these efforts are often invisible to Americans.

  

But can we actively engage the public in such an effort?  In a recent Research!America poll, 86 percent of Americans believe that it is important that they do more to prevent their own health problems.  This is clearly good news, however, few believe that preventable diseases and injuries are a major health problem. This paradox is best explained by what I call the burden problem. In general, both the public and policy makers have no idea what the leading causes of death and disability are, nor do they have any concept of the incidence of various diseases, such as the more than 400,000 Americans who die annually from tobacco-related diseases. This explains why the concept of disease burden is very unclear to most and why there can be such great concern about a serious but uncommon disease – such as pandemic influenza - and yet little concern about diseases that constitute the majority of deaths on a daily basis – such as heart disease and injuries.

 

The concept of prevention is easy to grasp in practical terms if you are talking about maintenance on a car.  However, it becomes harder to grasp when discussing the benefits of a healthy lifestyle since prevention is a multi-dimensional concept that has many components that produce results that are not always linear.  For example, while it is clear that a diet consisting of high fat and high caloric foods increases the risk of cardiovascular disease, other risk factors such as genetics, exercise, diabetes and lipids could affect a person’s physical well-being. In fact, the decision to have a single meal of high fat, high caloric foods does not put an individual at risk for poorer health, however, these behaviors do carry a risk over time, but that risk varies according to the individual.  With all these factors, people may have difficulty determining what behaviors they should immediately change in their lives. In addition, health communicators have done a poor job of communicating health dangers to the general public, often sending conflicting or confusing messages. The public is thus unable to connect the dots in ways that encourage healthy behaviors.

 

What then is the solution? How do we actively engage the public in such an important effort?  We can begin by:

• Enhancing the public’s knowledge of the value of health promotion and disease prevention,

• Improving our communication about the risks of unhealthy behaviors in ways that the public understands, maintaining consistent messages, so people can understand and follow proven advice, and

• Engaging Americans in public health decisions.

If the public and policy makers take this report’s call to action seriously, we will see a reinvigoration in the rate of health improvements experienced in the earlier years of this report. Only time will tell if this will be accomplished.