The Second Public Health Revolution: A Critical Appraisal

Abstract

This paper presents a critical reaction to the Surgeon General's recent report and recommendations on American health. Entitled Healthy People, the report has been described as providing impetus for a "second public health revolution." Our analysis leaves us less than enthusiastic. We first summarize the Report, noting its heavy emphasis on lifestyle. We then compare its tenets with those of the nineteenth century public health revolution. The Report recognizes social and economic conditions as significant factors in determining health but fails to incorporate this recognition in its policy recommendations. Instead, it places the burden of its recommendations on the reform of individual behavior. We explain this focus in terms of the continued centrality of the ideology of individualism and its collective counterpart, social and political pluralism. We then examine the ways in which these ideologies act on the Report and we suggest why the proposals they shape are unlikely to be successful.

The effects of workplace health promotion on absenteeism and employment costs in a large industrial population.

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] The effectiveness of workplace health promotion programs in reducing health risks has been demonstrated in the areas of high blood pressure control14-6 and smoking cessation. [17][18][19] The evidence is more tentative in other areas of lifestyle change.…”

Public health and health psychology: Two cats of Kilkenny?

“…Similar sentiments were voiced by Baker (1980), who suggested that passive prevention will prove maximally effective because “such protection is totally independent of the wisdom, caution, skill, and psychological makeup of the individuals who are protected” (p. 467). According to this public health position, the focus on individual life-styles is misplaced because it requires individuals to “redeem” themselves (Neubauer & Pratt, 1981). Thus the emphasis on the individual’s active behavioral life-styles is believed to “blame the victim” for his or her deficiencies (Editorial, 1980) and diverts attention from the social engineering or structural changes necessary to achieve better health of the population.…”

Best Practices in Integrating Theory and Practice in Graduate Education in Public Health Promotion

“…One of the most significant changes in the subject matter of public health education is a direct consequence of the epidemiological transition, the decline in infectious diseases and subsequent rise in chronic diseases. In what is sometimes hailed as the "second revolution" in public health, 1 the transition signaled a major historic shift in the field's primary focus, from controlling the agent of disease ("germs") to addressing the role of the host in disease etiology. While scientists continued to search for the microorganisms that caused heart disease or cancer well into the 1960s and 1970s, the 1979 U.S.…”