title: Citizen-centered health promotion: building collaborations to facilitate healthy living.
abstract: Unhealthy behaviors, notably tobacco use; unhealthy diets; and inadequate physical activity are major contributors to chronic disease in the U.S. and are more prevalent among socioeconomically disadvantaged groups. Differences in the prevalence of unhealthy behaviors among communities with different physical, social, and economic resources suggest that contextual environmental factors play an important causal role. Yet health promotion interventions often are undertaken in isolation and with inadequate attention to these holistic social and economic influences on lifestyle. For example, clinicians' advice to patients to stop smoking or lose weight can help motivate people to change behaviors, but their ability to take subsequent action can benefit from coordination with community-based and public health programs that offer intensive counseling services, and from modified environmental conditions to facilitate behavior change where people live, work, learn, and play. Reshaping these environmental conditions to support healthier living is the subject of six recommendations from the Robert Wood Johnson Foundation Commission to Build a Healthier America. Changing the conditions of daily life to make them conducive to healthy behaviors--what is here called citizen-centered health promotion--requires a concerted effort by clinical, educational, business, civic and governmental partners within communities. Linkages among clinical practices and community-based programs have been demonstrated to be effective, but moving from demonstration projects to sustainable community collaborations nationwide will require a proactive effort to establish the necessary infrastructure and financing.
authors.affiliation: Department of Family Medicine and Center on Human Needs, Virginia Commonwealth University, Richmond, Virginia 23298-0251, USA. swoolf@vcu.edu
authors.forename: Steven H
authors.initials: SH
authors.lastname: Woolf
authors.forename: Mercedes M
authors.initials: MM
authors.lastname: Dekker
authors.forename: Fraser Rothenberg
authors.initials: FR
authors.lastname: Byrne
authors.forename: Wilhelmine D
authors.initials: WD
authors.lastname: Miller
mesh_terms: D003256:Community Participation; D003159:Community-Institutional Relations; D015438:Health Behavior; D006265:Health Care Coalitions / Q000458:organization & administration*; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D054624:Health Status Disparities; D006801:Humans; D012959:Socioeconomic Factors; D014481:United States