For debate: a new wave in public health improvement.
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.
Office of the Chief Medical Officer, Department of Health, London, UK.
Sally C
SC
Davies
RAND Europe, Cambridge, UK.
Eleanor
E
Winpenny
RAND Europe, Cambridge, UK.
Sarah
S
Ball
Office of the Chief Medical Officer, Department of Health, London, UK; Field Epidemiology Services - West Midlands, Public Health England, Birmingham, UK; Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK.
Tom
T
Fowler
RAND Europe, Cambridge, UK.
Jennifer
J
Rubin
RAND Europe, Cambridge, UK. Electronic address: enolte@rand.org.
Ellen
E
Nolte
D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005544:Forecasting; D006285:Health Planning; D006293:Health Promotion / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D011050:Policy Making; D011634:Public Health / Q000379:methods / Q000639:trends*; D058996:Quality Improvement; D018570:Risk Assessment; D014481:United States