Chapter 29: Promoting Health and Wellness

INTRODUCTION

THE IMPORTANCE OF HEALTH PROMOTION AND WELLNESS INITIATIVES

Despite being among the wealthiest countries in the world,¹ and spending more than $2.3 trillion a year in health care,² the United States is ranked only 31st in healthy life expectancy by the World Health Organization (WHO).³ Some researchers have predicted that after years of increasing life expectancy, life expectancy in the United States will level off or even decline.⁴ Researchers and health professionals are struggling to understand this apparent discrepancy between health care expenditures and healthy life expectancy by examining and addressing the determinants of health in the U.S. population. An individual's health is determined by the interaction of numerous factors, including biology and genetics, social and physical environments, health services, and individual behaviors.⁵ The relative contribution of individual behaviors to levels of mortality and morbidity in the United States was first demonstrated in a landmark study published in 1993 by McGinnis and Foege.⁶ Tobacco use was estimated to be implicated in 19% of deaths, and poor diet and physical inactivity levels contributed to 14% of deaths in the United States in 1990. Mokdad et al⁷ later conducted a similar study to determine the behavioral contributors to premature death in the United States in 2000. Tobacco use was responsible for 18.1% of deaths, and poor diet and physical inactivity were estimated to be responsible for 16.6% of deaths.

Recent studies of the U.S. population have shown that these key behaviors of smoking, poor diet, and insufficient physical activity continue at high levels in the population. The Behavioral Risk Factor Surveillance System (BRFSS), the largest telephone survey in the world, tracks the health behaviors and health status of over 200,000 adults in the United States annually.⁸ The results of the BRFSS show that obesity levels in the country are climbing at an alarming rate (Fig. 29.1).⁹