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Delivering the Science
and the Art of Health Promotion |
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Robert F. Allen
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We need your help. We need you to join us in Washington DC, February 14-16, 2001 to persuade your senators and representative that the health of the American people and the economy will be enhanced by building health promotion into the national agenda.
Current State of Health Promotion
The science and art of health promotion has made very impressive progress in the past two decades. It has evolved from an innovative idea that made conceptual sense, but had no scientific backing to a maturing field supported by over 1,000 empirical studies which demonstrate the positive health and financial impact of programs, and practiced by virtually all major employers in the US.
Despite this progress, health promotion is not a part of mainstream medicine. Only a small fraction, probably less than 1%, of the $1.149 trillion spent annually on medical care is spent on health promotion. Despite the progress we have made on developing the science of health promotion, it is not recognized as a mature science by any respected scientific group.
Repeated analyses conclude that roughly half of all premature deaths in the United States are from lifestyle related causes. Indeed, conservative estimates are that tobacco kills 450,000; obesity kills 300,000; and alcohol kills 100,000. Sedentary lifestyle, unsafe sex practices, illegal drugs, accidents, and excess stress add a significant number to those totals. On the surface, heath promotion does seem to be an important part of federal policy. Health promotion is a center piece in the federal government's health objectives for the nation, which are articulated in the Healthy People 2010 document. Unfortunately, there is very little money to support the health promotion initiatives in this plan. Health promotion receives very little of the $17 billion NIH research budget and few health promotion procedures are covered by the $400+ billion spent annually for Medicare and Medicaid. The Office of Health Promotion and Disease Prevention has a budget so small that very few health promotion professionals ever encounter this office directly during their careers. The Centers for Disease Control and Prevention (CDC) are charged with coordinating the government's health promotion efforts but with the exception of some well funded and very important programs in tobacco control, and despite the strong interests of many staff members, CDC does very little to advance health promotion. There are also few incentives for insurance companies, managed care organizations or other health groups to incorporate health promotion into their plans.
To change this, to build health promotion into the national health care agenda, we as a profession need to create a strategic plan to make that happen. One important element will be to increase federal funding for health promotion, and that is the initial focus of our efforts in Building Health Promotion into the National Agenda.
Process
To advance this cause, we are following a multi step process:
- Consult with health promotion leaders, associations and other organizations to refine basic goals and select short term issues.
- Select a few issues to advocate in the short term
- Develop an advocacy plan to advance these issues, culminating in our February, 2001 Art and Science of Health Promotion Conference in Washington, DC.
- Develop a long term plan and issues to advocate on a long term basis.
We have made good progress in steps 1, 2 and 3. Through discussions with the
150+ members of our editorial board, discussions and brainstorming during one of
the general sessions at our March 6-11, 2000 Art and Science of Health Promotion
Conference, and communication with over 50 health organizations, we have
developed an initial set of short term goals and issues, and a tentative
advocacy plan. We are now sharing this plan with our core group and the general
public for comment and refinement.
Short term goals and issues
We reviewed dozens of issues suggested by our advisors using the criteria
below outlined by Mike Miller of the Organize Training Center in San Francisco.
Mr. Miller suggests that advocacy issues should be:
- winnable;
- simple and specific such that anyone can explain them in a sentence or two;
- involve our constituency in a meaningful way;
- effect lots of people;
- build up our community (in this case our advocacy group):
- contribute to a larger plan or strategy.
Based on these criteria we selected two issues to advocate.
1. Increase research funding for health promotion. One of our issues will
be to increase research funding for health promotion to better reflect the
burden of illness and death caused by lifestyle related problems. To date, very
few long term or large scale health promotion related studies have been
conducted because of lack of access to sufficient resources. In fact, we have
not even developed a widely accepted research agenda to guide research in health
promotion. In addition to preventing the development of a solid science base for
our field, lack of research funding discourages scientists from pursuing health
promotion as a field of study.
We are still working to determine the portion of NIH funding devoted to health
promotion. NIH officials have told us that 25% of NIH's budget is devoted to the
broad area of "prevention," but this includes research related to
immunizations, disease screenings, early intervention medical procedures, but
very little research on how to help people enhance their lifestyle or create
environments which encourage healthy lifestyle practices. Our best guess is that
less that 2% of NIH's budget is devoted to health promotion per se; we are still
working to get a better estimate. Given that 50% of premature deaths are caused
by lifestyle related problems, it seems reasonable that 50% of NIH's budget
should eventually be devoted to health promotion, but in the short term an
increase to 10% would make a huge impact on our field.
We selected this issue because increased research funding is necessary to
solidify the research base supporting our field. Without this research base, we
cannot improve the impact of our programs, our field will never be accepted as a
science by the scientific community, and health promotion will not become a part
of main stream health care. We also selected this issue because we anticipate
strong participation from the academic community in the advocacy efforts related
to this issue.
2. Increase funding for dissemination of information on health promotion. Our
second issue will be to secure increased funding to disseminate information on
existing research results and best practices to program managers. As stated
above, we must enhance our science base significantly to push health promotion
to the next stage in its evolution. Nevertheless, we have made excellent
progress with the limited resources we have been able to secure. An excellent
scientific base has been established. Furthermore, the experienced practitioners
working in the best programs have developed significant wisdom on the art of
health promotion. Unfortunately, there is still a huge gap between the science
base we have developed, the best programs and the typical programs. We need to
narrow these gaps by better organizing and disseminating the information we
already have.
We have not yet determined how much is currently being spent on dissemination of
health promotion information or through which government agencies this money
flows. Our investigation in this area continues.
We selected this issue because the effectiveness of existing programs could be
significantly enhanced if the leaders of these program had a better grasp of
existing research results and best practice techniques. Also, we anticipate
strong participation from the practitioner community in the advocacy efforts
related to this issue.
Advocacy plan
To addresses these two issues, our advocacy plan has four basic elements.
1. Coordinate with other organizations. We will coordinate with other
organizations such as Research America, Partnership for Prevention, Center for
Science in the Public Interest, Campaign for Tobacco Free Kids, as well as a
wide range of universities, professional associations, health promotion
businesses, and employers. Our goal is to develop a long term plan which will
support their goals, leverages their knowledge resources and create a new
synergy for these efforts. We recognize that this will be a complicated process.
Indeed, on a weekly basis, we continue to discover organizations which are
potential allies.
2. Contact every member of the House of Representatives and Senate. We
are attempting to have a personal visit with every member of the national House
of Representatives and Senate or an influential member of their staff to explain
the health and financial benefits of health promotion and to advocate for
increased funding for health promotion research and dissemination of information
(our two issues above).
3. Create a grass roots network and central coordinating team. To be
successful in advocating our selected issues, and reach every member of the
House of Representatives and Senate, we need to have a committed and extensive
network of health promotion professionals who are willing to call, write, and
visit with their senators and congressional representative to advocate these
issues. We will probably access these professionals through the professional
associations participating in this effort. In the short term, we will provide
guidelines on our web page on how to contact senators and representatives .
We also need a small more sophisticated group of people to develop a long term
strategy for this effort.
4. Stage a conference to advance this effort.
The theme of our February 12-17, 2001 Art and Science of Health Promotion
Conference is "Building Health Promotion into the National Agenda."
This conference will be held at the Omni Shoreham Hotel in Washington, DC and
will be the culminating point of our short term efforts. During the conference,
we will train people how to meet with their senators and representatives and
well as visit Capital Hill en masse. Before the conference, we will provide
guidelines on how to set up appointments.
An entire track of the conference will be devoted to the political advocacy
process and another to current and potential national, state and local health
promotion policy efforts. To provide backup for these efforts, additional
conference tracks will be devoted to describing the best evidence on the health
and financial impact of health promotion, and the strategies that have proven
most effective. More conference details can be found at the conference web site:
http://HealthPromotionConference.org
To enhance the impact of the conference, the American Journal of Health
Promotion will be co-sponsoring this conference in conjunction with the Wellness
Councils of America (WELCOA), the Health Education and Health Promotion section
of APHA, and the Health Promotion Research Foundation and the Association for
Worksite Health Promotion. We are discussing further co-sponsorship
possibilities with a number of other organizations.
Long term plan
We will develop a long term plan over the next year. The long term plan will
include issues we will advocate on a long term basis and organizational plans to
support a long term advocacy effort.
What can you do?
It should be clear that we can not be successful in this effort without your
help. You can help in the following ways.
- Contact us to let us know how you would like to participate.
telephone: 248-682-0707
fax: 248-682-1212
mail:
American Journal of Health Promotion,
1660 Cass Lake Road, #104,
Keego Harbor, MI 48320
email: NationalAgenda@HealthPromotionConference.org
- Call, send a letter or visit the local office of both of your senators and
your representative to inform them of the concept of health promotion and
advocate support for these two specific issues. For details on how to do
this, visit our National Agenda web site at:
http://HealthPromotionConference.org/NationalAgenda
- Come to the February 12-17, 2001 Art and Science of Health Promotion
Conference to be part of our culminating visit to Capital Hill.
Michael P. O'Donnell, PhD, MBA, MPH
Editor in Chief, American Journal of Health Promotion
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