qq-11 - Structural Interventions for Addressing Chronic...

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current as of August 21, 2009. Online article and related content http://jama.ama-assn.org/cgi/content/full/302/6/683 . 2009;302(6):683-685 (doi:10.1001/jama.2009.1147) JAMA Mitchell H. Katz Problems Structural Interventions for Addressing Chronic Health Correction Contact me if this article is corrected. Citations Contact me when this article is cited. Topic collections Contact me when new articles are published in these topic areas. Psychosocial Issues; Public Health; Exercise; Tobacco; Diet Occupational and Environmental Medicine; Patient-Physician Relationship/ Care; http://pubs.ama-assn.org/misc/permissions.dtl permissions@ama-assn.org Permissions http://jama.com/subscribe Subscribe reprints@ama-assn.org Reprints/E-prints http://jamaarchives.com/alerts Email Alerts at Brigham Young University on August 21, 2009 www.jama.com Downloaded from
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COMMENTARY Structural Interventions for Addressing Chronic Health Problems Mitchell H. Katz, MD T HE CHRONIC HEALTH PROBLEMS OF OBESITY, DIABE- tes, heart disease, and cancer commonly affect adults living in developed countries and are both difficult to treat and costly, leading experts to stress the importance of prevention. 1 Elimination of the 3 behavioral risk factors of sedentary lifestyle, poor diet, and smoking would decrease mortality by 35%. 2 But how do we get individuals to exercise more, eat better, and stop smoking? Health education has been effective in diminishing these risk factors, especially smoking, but education alone is un- likely to bring further progress. In fact, it would be diffi- cult to find a sedentary obese smoker who did not know that he should exercise more, eat less, and stop smoking. Intensive one-to-one and group behavioral interven- tions have been demonstrated to increase activity, 3 reduce obesity, 4 and promote smoking cessation, 5 but effects have been modest and difficult to maintain. Moreover, translat- ing these findings into practice has been hampered by in- sufficient funding and difficulty reaching those persons in greatest need. Structural interventions offer a complementary ap- proach to improving health by focusing on changing the physical, social, and economic environment. 6 The interven- tions are structural in that, unlike individualized interven- tions, persons do not enroll or even know that they are par- ticipating. Structural interventions are not a new idea. The increase in longevity that occurred in the early 20th century was largely due to physical improvements in the environment (eg, sewage treatment) and at work sites (eg, safer equip- ment). Other successful structural interventions include seat belts in cars, road safety standards, elimination of toxins such as lead in paint and gasoline, and water fluoridation. What is new, and potentially more challenging, is the use of struc- tural interventions for chronic diseases. Structural Interventions to Increase Physical
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qq-11 - Structural Interventions for Addressing Chronic...

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