Staying the Health Promotion Course

Once upon a time in the 1980s, public concern about drug abuse prevention was at a fever pitch.  The issue got heavy attention in media.  Political leaders, including Presidents spoke about it.  Corporations wanted press coverage for charitable gifts made to drug abuse prevention efforts.  Grass roots efforts in local communities proliferated to confront the "menace of drug abuse."  With all this attention and support, serious government resources flowed to programs and policy strategies.  While success was not proportionate to the size of the effort, progress was made.

Today, drug abuse has largely disappeared from the popular radar screen.  There is little if any discussion of drug abuse in political campaigns.  If there are news stories about it, they get a yawn or a change-the-channel reflex.  What we don't know is whether this lack of focus and determination will lead to a resumption of the drug epidemic.  There is reason to be concerned.

We have seen this with vaccination.  In the 1950s and 60s, the public had firsthand knowledge of infectious epidemics.  The ambient fear and respect for childhood infections translated into widespread support for vaccinating children.  The new vaccines were welcomed as wonder drugs.

As the decades have passed since then, a lot of apathy has set in.  Parents today have no memory of children severely sick and disabled from infections of early life.  This has given rise to apathy when it comes to getting children immunized.  At the same time, some parents believe, without any evidence, that vaccination is a cause of autism.  In addition, birthing has seen a relative shift away from mainstream to low income minorities and particularly Hispanic families.  This presents access and health literacy barriers to vaccination, making the job more complicated.  Nevertheless, there is reason to be concerned that as a society we take our eyes off this particular ball, allowing rates of measles, mumps, pertussis and polio to rise again.

To an extent we are seeing this happen with a shift of attention away from tobacco toward obesity prevention.  It feels like our commitment to tobacco control is running out of steam.  While overweight and obesity is a very serious problem, tobacco is still with us, taking over 1,000 U.S. lives a day.  We should be concerned that society may be losing interest, and will pay a price of increased smoking rather than pushing a continuing decline.

So then, the key question is how do we in public health prolong the attention span?  How do we keep individuals, institutions and government agencies focused on a health promotion task when it is no longer exciting in the public's eye?  How do we break the cycle of fits and starts, always moving on to
 the next big thing?

I don't have the final answer, but offer two things to consider.  The first has to do with insisting on strategic planning driven by community needs, rather than funding opportunities.  Public health agencies are often seduced into designing programs because funding is available.  This gives rise to a cycle of always moving on, whether or not a job has really been completed, which of course, it usually has not.

Recently, a lot of federal stimulus money has been invested in community health programs around the country.  Communities were invited to compete for these funds.  It was not a coincidence that the ending date for the health projects is spring, 2012.  The initiation and success of these projects are part of the strategy for the 2012 Presidential campaign.  Campaign strategists want to be able to point to successful stimulus spending.  This point is not to fault the projects, but to say that beginning with funding opportunities is not always the same as beginning with local health priority needs.

The second way to help break the cycle is to rely more on theory-driven, evidence-based strategies and solutions, and to constantly fine tune our interventions with careful evaluation.  Some of the reason for losing interest is because the things we do are not effective, so people become demoralized and give up.  Demanding more connection between research and program planning, and relentless attempts to find more effective methods might keep people engaged and inspired for the long haul.

In the end, we are talking about human nature and social evolution that we have few tools to manage.  Nevertheless, it is health promotion's burden to keep people striving until the work is done, not before.