Department of Family Medicine and Center on Human Needs, Virginia Commonwealth University, Richmond, Virginia 23298-0251, USA.
Am J Prev Med. 2011 Jan;40(1 Suppl 1):S38-47. doi: 10.1016/j.amepre.2010.09.025.
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.
不健康的行为，尤其是吸烟、不健康的饮食和缺乏身体活动，是导致美国慢性病的主要因素，而且在社会经济处于不利地位的群体中更为普遍。在具有不同物质、社会和经济资源的社区中，不健康行为的流行程度存在差异，这表明环境因素在因果关系中起着重要作用。然而，健康促进干预措施通常是孤立进行的，而且对生活方式的这些整体社会和经济影响关注不足。例如，临床医生建议患者戒烟或减肥，可以帮助激励人们改变行为，但他们采取后续行动的能力可以从与以社区为基础和公共卫生为基础的计划相协调中受益，这些计划提供强化咨询服务，并从修改环境条件中受益，以促进人们生活、工作、学习和娱乐的地方的行为改变。重塑这些环境条件以支持更健康的生活是罗伯特伍德约翰逊基金会建设更健康美国委员会的六项建议的主题。改变日常生活条件，使其有利于健康行为——这里称为以公民为中心的健康促进——需要临床、教育、商业、公民和政府合作伙伴在社区内共同努力。已经证明临床实践和以社区为基础的计划之间的联系是有效的，但是从示范项目向全国范围内可持续的社区合作转变，需要积极努力建立必要的基础设施和资金。
