Citizen-Centered Health Promotion

Building Collaborations to Facilitate Healthy Living

A review of findings that support a citizen-centered approach to improving health behaviors argues that lasting change in individuals' health behaviors requires collaboration among communities’ clinical, business, educational, civic and governmental entities.

Social and environmental factors usually play a minor role in efforts to improve health behaviors, even though interventions addressing the socioeconomic conditions behind health behaviors are often the most effective. The Robert Wood Johnson Commission to Build a Healthier America has recommended a citizen-centered approach that places health behaviors in the context of individuals' living conditions.

The authors reviewed the evidence behind the Commission's recommendations and found support for a citizen-centered approach: reductions in tobacco use have come from public policy and cultural changes rather than education campaigns about tobacco's health risks, and obesity has a greater relationship to socioeconomic status than to whether individuals are educated about exercise and nutrition. The authors critique the common assumption that unhealthy behaviors are solely the product of individuals' unhealthy choices, and argue that effective interventions must address the environmental opportunities and obstacles that shape health behaviors.

Challenges to implementing a citizen-centered approach to improving health behaviors include long-term financial sustainability; the development of infrastructure to connect disparate community entities; and how to prioritize health behaviors.