Has Health Promotion Reached the Tipping Point?
Volume 22, Issue 6

Download a free PDF copy of this article

For each of the past 29 years, I have been enamored with the health promotion concept; it’s the coolest concept I can imagine. People can improve their health and quality of life by doing some pretty basic and palatable things like being active, eating nutritious foods, avoiding abusive substances, and having a positive outlook on life. If they do these things, their medical costs are lower, and they are more productive. What could be cooler? For 28 years in a row, I have been repeatedly puzzled how such a great idea was not spreading like wild fire. This year, I think we turned the corner. This year, I believe we have reached the Tipping Point, defined by Malcolm Gladwell as "the moment of critical mass, the threshold, the boiling point,”¹ and by Bryan Walsh as " . . . the levels at which the momentum for change becomes unstoppable."² The foundational wisdom behind the idea has not changed: an estimated 40% of premature deaths³ and at least 25% of medical costs⁴ are caused by lifestyle factors. What has pushed us over the top? I think the most important factors have been medical costs reaching the point of threatening the survival of major companies like General Motors, the visibility of an obesity epidemic that threatens to produce more annual deaths than tobacco within a decade, the success of tobacco control programs that cut the smoking rate in half, and the sophistication of health promotion programming methods which have produced encouraging successes in workplace, clinical, and community settings. What are some of the signs that lead me to conclude we have reached the tipping point? Some are objective and others are subjective. I have space to list a few of them here.

Health Promotion Business. The earliest indication was the growth of health promotion businesses. Despite a recession related stall in 2007-2008, many of the larger workplace health promotion providers experienced record growth in 2004, 2005, and 2006. In many cases, their growth was limited only by difficulty in hiring skilled staff members. For example, one large benefit’s consulting firm that helps large employers and health plans develop and evaluate health promotion programs grew from 12 consultants in 2004, to 25 full-time and 33 part-time consultants in 2008. Many of the small health promotion companies started by my colleagues 20 years ago have been acquired, for princely sums, by large companies that were not even involved in health promotion 5 years ago. The least visible, but perhaps most important indicator that health promotion programs are about to become an integral part of the workplace is the interest expressed by the World Economic Forum at their recent meetings in Dalian, China, and Davos, Switzerland.⁵ The World Economic Forum is an alliance of the CEOs of the world’s largest companies and the heads of state of the nations of the world. Their support could stimulate the field to grow multifold over the next decade, especially outside the United States.

Embrace by the disease/medical community. The early suspicions of the medical community have evolved into enthusiastic support for health promotion. For example, C-Change, a high level group of the nation’s cancer experts has made health promotion the center piece of their efforts, citing their conclusions that only 5% of cancers are caused by genetics, one-third are caused by tobacco, and one-third by nutrition.⁶ The American Heart Association became a vocal advocate of prevention of heart disease through lifestyle more than a decade ago. Most of the largest and medium-sized health insurance companies and several of the most highly rated hospitals have made significant commitments to health promotion.

Health Promotion Legislation. I have written frequently about legislation supported by Health Promotion Advocates that provides a more solid planning and science base for health promotion (S866 Health Promotion FIRST) and tax credits for comprehensive workplace programs (S1754)⁷. These pieces of legislation were unusual when they were first introduced, but a recent search of federal legislation introduced since 2007 uncovered 74 bills that use the term “health promotion” and 89 that use the term “Wellness.”⁸

Policy. Aggressive policies have been passed at the city, state, and national levels to support healthy lifestyle practices, especially to provide smoke-free workplaces. Twenty-six of the 50 states in the US prohibit smoking in the workplace and only four of them exempt bars and restaurants. Equally impressive, 30 nations have complete bans of smoking in the workplace and 10 additional have partial bans.⁹

Global Warming and Sustainability. The factor that convinced me we had reached the tipping point was a series of articles in The Lancet that suggested health promotion supportive policy changes as part of the solution to global warming. The authors pointed out that meat production was responsible for 18% and transportation¹⁰ for 22% of global gas emissions and suggested that reducing meat consumption¹¹ and stimulating active transportation strategies were compelling strategies to combat global warming.

Implications. If we have reached the tipping point, what are the implications? On the plus side, people, organizations, and governments will take our ideas seriously. We will be able to advance agendas that previously had little chance of success. We will have far more resources than most of us ever imagined, and we will have great career opportunities in clinical, business, academic, and community settings. On the challenge side, we will have a labor shortage, especially in leadership positions. This means we need to take measures to expand educational programs to train people for entry-level positions, and we need to come up with creative solutions for expanding in our leadership ranks. We will also be held more accountable for producing measurable outcomes. The expectation will not be on producing remarkable changes in health or cost savings, but in having reliable systems in place to document processes and outcomes. Of course, we must continue to improve our outcomes, so we need to continue to refine the science and art guiding our work.

Of course, the most exciting and most important implication is the possibility of significantly enhancing the health of our nation and the world.

Michael P. O'Donnell, PhD, MBA, MPH

References

1. Gladwell, M. The Tipping Point: How Little Things Can Make a Big Difference Little Brown in 2000
    
2. Walsh, Bryan. "A green tipping point", Time Magazine, 2007-10-12.
    
3. McGinnis JM, Williams-Russo P, Knickman JR. The Case For More Active Policy Attention To Health Promotion Health Affairs, 2002 - Health Affairs 21:22, 78-93
    
4. Anderson DR, Whitmer RW, Goetzel RZ, Ozminkowski RJ, Wasserman J, Serxner S The Relationship Between Modifiable Health Risks and Group-level Health Care Expenditures, American Journal of Health Promotion, 2000, 5, 15, 1
    
5. O’Donnell, MP, 2007 The Next Stage of Evolution of Workplace Wellness: A World Economic Forum/World Health Organization Collaboration, American Journal of Health Promotion, 22, 2, vi
    
6. C-Change web site http://www.c-changetogether.org/ Accessed April 12, 2008.
    
7. Health Promotion Advocates website: http://www.HealthPromotionAdvocates.org. Accessed April 12, 2008
    
8. The Library of Congress Thomas website: http://www.thomas.gov/ Accessed April 12, 2008
    
9. Wikipedia, List of Smoking Bans, http://en.wikipedia.org/wiki/List_of_smoking_bans Accessed April 12, 2008.
    
10. Woodcock J, Banister D, Edwards P, Prentice AM, Roberts I, 2007 Energy and transport, Lancet, 2007; 370:1078-1088
     
11. McMichael A, Powles J, Butler C, Uauy R, 2007, Food, livestock production, energy, climate change, and health, Lancet, 2007; 370:1253-1263