For debate: a new wave in public health improvement

• Published in: The Lancet (British edition) 2014-11, Vol.384 (9957), p.1889-1895
• Main Authors: Davies, Sally C, MBChB, Winpenny, Eleanor, PhD, Ball, Sarah, PhD, Fowler, Tom, PhD, Rubin, Jennifer, PhD, Nolte, Ellen, Dr
• Format: Article
• Language: English
• Subjects: Antimicrobial agents; Biological and medical sciences; Cardiovascular disease; Chronic Disease - epidemiology; Chronic Disease - therapy; Chronic illnesses; Culture; Disease transmission; Drug resistance; Female; Forecasting; General aspects; Health care; Health disparities; Health Planning; Health promotion; Health Promotion - organization & administration; Health Services Needs and Demand; Health Status Disparities; Humans; Infectious diseases; Internal Medicine; Male; Medical sciences; Miscellaneous; Optimization; Policy Making; Public health; Public Health - methods; Public Health - trends; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality Improvement; Risk Assessment; Social behavior; System effectiveness; Tuberculosis; United States
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(13)62341-7

Summary The rising burden of chronic disease poses a challenge for all public health systems and requires innovative approaches to effectively improve population health. Persisting inequalities in health are of particular concern. Disadvantage because of education, income, or social position is associated with a larger burden of disease and, in particular, multimorbidity. Although much has been achieved to enhance population health, challenges remain, and approaches need to be revisited. In this paper, we join the debate about how a new wave of public health improvement might look. We start from the premise that population health improvement is conditional on a health-promoting societal context. It is characterised by a culture in which healthy behaviours are the norm, and in which the institutional, social, and physical environment support this mindset. Achievement of this ambition will require a positive, holistic, eclectic, and collaborative effort, involving a broad range of stakeholders. We emphasise three mechanisms: maximisation of the value of health and incentives for healthy behaviour; promotion of healthy choices as default; and minimisation of factors that create a culture and environment which promote unhealthy behaviour. We give examples of how these mechanisms might be achieved.