The estimated 800,000 U.S. deaths in 1990 related to behavioral decisions challenge physicians to better assist behavioral change through expanded health promotion activities. Based on the format guidelines of this special issue, this brief paper first examines the current and optimal roles of health promotion within Preventive Medicine, including five physician roles for improving modifiable public health-risk behavior burdens: (1) preventive services clinician, (2) health promotion researcher, (3) educator-communicator, (4) systems manager, and (5) health promotion advocate. After presenting a new vision statement, this paper proceeds to discuss the opportunities and barriers, including system, clinician-office, and patient factors, to attaining this new vision of empowering health promotion within Preventive Medicine. Finally, all physicians are invited to engage in a threefold strategic plan for change through at least one of five action items: (1) health promotion advocacy, (2) health promotion research, (3) public communication, (4) protocol dissemination and implementation, and (5) Preventive Medicine training.
Get full access to this article
View all access options for this article.
References
1.
McGinnisJMFoegeWH. Actual causes of death in the United States. JAMA. 1993;270(18):2207–2212.
2.
KoopEC. Health promotion and disease prevention in clinical practice. In: WoolfSHJonasSLawrenceRS, eds. Health Promotion and Disease Prevention in Clinical Practice. Baltimore, Md: Williams & Wilkins, 1996:vii–ix.
3.
O'DonnellM. Definition of health promotion: part III: expanding the definition. Am J Health Promot. 1989;3(3):5.
CrabtreeBFMillerWLAitaVA. Primary care practice organization and preventive services delivery: a qualitative analysis. J Fam Pract. 1998;46(5):404–409.
6.
US Dept of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed.Washington, DC: US Government Printing Office; 2000.
7.
WechslerHLevineSIdelsonRK. The physician's role in health promotion revisited—a survey of primary care practitioners. N Engl J Med. 1996;334(15):996–998.
8.
SmedleyBDSymeSL, eds. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: National Academy Press; 2000.
9.
US Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Baltimore, Md: Williams & Wilkins; 1989.
10.
A Step-by-Step Guide to Delivering Clinical Preventive Services: A Systems Approach. Put Prevention into Practice. Rockville, Md: Agency for Healthcare Research and Quality; 2001.
11.
Task Force on Community Preventive Services. Guide to community preventive services: systematic reviews and evidence-based recommendations. Available at: http://www.thecommunityguide.org. Accessed September 20, 2002
12.
CoffieldABMaciosekMVMcGinnisJM. Priorities among recommended clinical preventive services. Am J Prev Med. 2001;21:1–9.
13.
KaplanRM. Two pathways to prevention. Am Psychol. 2000;55(4):382–396.
14.
MeyersDGSteinleBT. Awareness of consensus preventive medicine practice guidelines among primary care physicians. Am J Prev Med. 1997;13:45–50.
15.
CalfasKJLongBJSallisJF. A controlled trial of physician counseling to promote the adoption of physical activity. Prev Med. 1996;25:225–233.
16.
MarcusBHGoldsteinMGJetteA. Training physicians to conduct physical activity counseling. Prev Med. 1997;26:382–388.
17.
PintoBMGoldsteinMBDePueJDMilanFB. Acceptability and feasibility of physician-based activity counseling: the PAL project. Am J Prev Med. 1998;15:95–102.
18.
Simons-MortonDGBlairSNKingAC. Effects of physical activity counseling in primary care. The activity counseling trial: a randomized controlled trial. JAMA. 2001;286(6):677–687.
19.
EdenKBOrleansCTMulrowCD. Does counseling by clinicians improve physical activity? A summary of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2002;137(3):208–215.
20.
LaineCDavidoffFLewisCE. Important elements of outpatient care: a comparison of patients' and physicians' opinions. Ann Intern Med. 1996;125(8):640–645.
21.
LaneDSRossVChenDWO'NeillC. Core competencies for preventive medicine residents version 2.0. Am J Prev Med. 1999;16(4):367–372.
22.
Association of American Medical Colleges. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. Washington, DC: Liaison Committee on Medical Education; June 2002.
23.
The Informatics Panel and the Population Health Perspective Panel. Contemporary issues in medicine—medical informatics and population health: report II of the medical school objectives project. Acad Med. 1999;74(2):130–141.
24.
SabharwalR.Trends in medical school graduates' perceptions of instruction in population-based medicine. Assoc Am Med Coll Analysis in Brief. 2002;2:1–2.
25.
MullerS.Physicians for the twenty-first century: report of the project panel on the general professional education of the physician and college preparation for medicine. J Med Educ. 1984;59(11 pt 2):1–208.
26.
McClaryAMMarantzPTaylorMH. Preventive medicine 2000: changing contexts and opportunities. Acad Med. 2000;75(7): S22–S27.
27.
ElsterABCallanCM. Physician roles in medicine–public health collaboration: future directions of the American Medical Association. Am J Prev Med. 2002;22(3):211–213.
28.
KinsingerL. Teaching prevention in internal medicine clerkships. Acad Med. 2000;75(7): S60–S65.
29.
DandoyS. Preventive medicine: where are we going? How do we get there?Am J Prev Med. 1998;14:73–74.
30.
AltoWA. Prevention in practice. Prim Care. 1995;22(4):543–554.
31.
McGinnisJMWilliams-RussoPKnickmanJR. The case for more active policy attention to health promotion. Health Aff. 2002;21(2):78–93.
32.
ThompsonRS. What have HMOs learned about clinical prevention services? An examination of the experience at Group Health Cooperative of Puget Sound. Milbank Q. 1996;74(4):469–509.
33.
KindigDA. Purchasing Population Health: Paying for Results. Ann Arbor, Mich: University of Michigan Press; 1997.
34.
MedderJSusmanJLGilbertCCrabtreeBF. Dissemination and implementation of Put Prevention Into Family Practice. Am J Prev Med. 1997;13(5):345–351.
35.
HensrudDD. Clinical preventive medicine in primary care: background and practice: 1. Rationale and current preventive practices. Mayo Clin Proc. 2000;75:165–172.
36.
StangeKCWoolfSHGjeltemaK. One minute for prevention: the power of leveraging to fulfill the promise of health behavior counseling. Am J Prev Med2002;22(4):320–323.
37.
OckeneISHaymanLLPasternakRC. Task force #4—adherence issues and behavior changes: achieving a long-term solution. J Am Coll Cardiol. 2002;40(4):579–651.
38.
McGinnisJM. Does proof matter? Why strong evidence sometimes yields weak action. Am J Health Promot. 2001;15(5):391–396.
39.
SolbergLIKottkeTEBrekkeML. The case of the missing clinical preventive services systems. Eff Clin Pract. 1998;1:33–38.
40.
SolbergLIKottkeTEBrekkeML. Will primary care clinics organize themselves to improve the delivery of preventive services? A randomized controlled trial. Prev Med. 1998;27:623–631.
41.
EwingGBSelassieAWLopezCHMcCutcheonEP. Self-report of delivery of clinical preventive services by US physicians: comparing specialty, gender, age, setting of practice, and area of practice. Am J Prev Med. 1999;17:62–72.
42.
DickeyLLGemsonDHCarneyP. Office system interventions supporting primary care-based health behavior change counseling. Am J Prev Med. 1999;17(4):299–308.
43.
WhitlockEPOrleansCTPenderNAllanJ. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med. 2002;22(4):267–284.
44.
Office of Behavioral and Social Sciences Research. Putting Evidence Into Practice. Bethesda, Md: National Institutes of Health, Office of Behavioral and Social Sciences Research; 1999.
45.
NoellJGlasgowRE. Interactive technology applications for behavioral counseling: issues and opportunities for health care settings. Am J Prev Med. 1999;17(4):269–274.
46.
ParkinsonMDLurieP. Reimbursement for preventive services. In: WoolfSHJonasSLawrenceRS, eds. Health Promotion and Disease Prevention in Clinical Practice. Baltimore, Md: Williams & Wilkins; 1996:525–542.
47.
FaulknerLASchaufflerHH. The effect of health insurance coverage on the appropriate use of recommended clinical preventive services. Am J Prev Med. 1997;13(6):453–458.
48.
GoodsonPGottliebNHSmithMM. Put Prevention Into Practice: evaluation of program initiation in nine Texas clinical sites. Am J Prev Med. 1999;17:73–78.
49.
StineCKohrsFPLittleDN. Integrating prevention education into the medical school curriculum: the role of departments of family medicine. Acad Med. 2000;75(7): S55–S59.
50.
ChengTLGreenbergLLoeserHKellerD. Teaching prevention in pediatrics. Acad Med. 2000;75(7): S66–S71.
51.
WolfsonP. Teaching prevention in surgery—is it an oxymoron?Acad Med. 2000;75(7): S77–S84.
52.
GarrDRLacklandDTWilsonDB. Prevention education and evaluation in US medical schools: a status report. Acad Med. 2000;75(7): S14–S21.
53.
BlueAVBarnetteJJFergusonKJGarrDR. Evaluation methods for prevention education. Acad Med. 2000;75(7): S28–S34.
54.
LaneDS. A threat to the public health workforce: evidence from trends in preventive medicine certification and training. Am J Prev Med. 2000;18:87–96.
55.
BlumenthalDSBarkerWHMarantzP. Response to the report of the AAMC Population Health Perspective Panel. Am J Prev Med. 2000;18:102–103.
56.
SachdevaAK. Faculty development and support needed to integrate the learning of prevention in the curricula of medical schools. Acad Med. 2000;75(7): S35–S42.
57.
HensrudDD. Clinical preventive medicine in primary care: background and practice: 2. Delivering primary preventive services. Mayo Clin Proc. 2000;75:255–264.
58.
KottkeTEEdwardsBSHagenPT. Counseling: implementing our knowledge in a hurried and complex world. Am J Prev Med. 1999;17(4):295–298.
59.
MorrowJRJacksonAWBazzarreTL. A one-year follow-up to physical activity and health: a report of the surgeon general. Am J Prev Med. 1999;17:24–30.
60.
LurieN. What the federal government can do about the nonmedical determinants of health. Health Aff. 2002;21(2):94–106.
61.
OrleansCTGrumanJUlmerC. Rating our progress in population health promotion: report card on six behaviors. Am J Health Promot. 1999; 14(2):75–82.
62.
OrleansCT. Promoting the maintenance of health behavior change: recommendations for the next generation of research and practice. Health Psychol. 2000;19(suppl):76–83.
63.
ShephardRJ. Whistler 2001: a Health Canada/CDC conference on “Communicating physical activity and health messages: science into practice.”Am J Prev Med. 2002;23(3):221–225.
64.
SolbergLIKottkeTEConnSA. Delivering clinical preventive services is a systems problem. Ann Behav Med. 1997;19(3):271–278.
65.
GlasgowREOrleansCTWagnerEH. Does the chronic care model serve also as a template for improving prevention?Milbank Q. 2001;79(4):579–612.
66.
FramePS. Computer-assisted decision making and reminder systems. In: WoolfSHJonasSLawrenceRS, eds. Health Promotion and Disease Prevention in Clinical Practice. Baltimore, Md: Williams & Wilkins; 1996:543–553.
67.
ThompsonBLNelsonDECaldwellBHarrisJR. Assessment of health risk behaviors: a tool to inform consumers, providers, health care organizations, and purchasers. Am J Prev Med. 1998;16:48–59.
68.
MarcusBHNiggCRRiebeDForsythLH. Interactive communication strategies: implications for population-based physical-activity promotion. Am J Prev Med. 2000;19(2):121–126.
69.
KreterMWChhedaSGBullFC. How does physician advice influence patient behavior? Evidence for a priming effect. Arch Fam Med. 2000;9:426–433.
PomrehnPRDavisMVChenDWBarkerW. Prevention for the 21st century: setting the context through undergraduate medical education. Acad Med. 2000;75(7): S5–S13.
72.
DismukeSEMcClaryAM. Putting it all together: building a four-year curriculum. Acad Med. 2000;75(7): S90–S92.
73.
American College of Preventive Medicine. Recommendations: how we get there. From: the specialty of preventive medicine: leadership in medicine for the 21st century. A report of the Forum for Leadership in the Specialty of Preventive Medicine, September 1996. Am J Prev Med. 1998;14:75–77.
74.
NitzkinJL. American College of Preventive Medicine/American Association of Public Health Physicians Job Market Initiative. Committee in progress. Available at: http://www.aaphp.org. Accessed September 16, 2002.
75.
JohnsonJLGreenLWFrankishCF. A dissemination research agenda to strengthen health promotion and disease prevention. Can J Public Health. 1996;87(suppl):S5–S10.
76.
JonesTFowlerMCHubbardD. Refining a tool to measure cues to action in encouraging health-promoting behavior—the CHAQ. Am J Health Promot. 2000;14(3):170–173.
77.
WallackL. The role of mass media in creating social capital: a new direction for public health. In: SmedleyBDSymeSL, eds. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: National Academy Press; 2000:337–365.
78.
US Dept of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, Ga: US Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.
79.
KottkeTEBrekkeMLSolbergLI. Making “time” for preventive services. Mayo Clin Proc. 1993;68:785–791.
80.
WoolfSHAtkinsD. The evolving role of prevention in health care: contributions of the US Preventive Services Task Force. Am J Prev Med. 2001;20(suppl 3):13–20.
81.
American College of Preventive Medicine. A public health crisis: the shortage of physicians trained in preventive medicine. Available at: http://www.acpm.org. Accessed September 27, 2002.
82.
American College of Preventive Medicine Headlines. Newsletter from January 11, 2002. Available at: http://www.acpm.org. Accessed September 20, 2002.
83.
ParkinsonMDScutchfieldFD. From public health and medicine to population health improvement: the 50-year search for training in preventive medicine. Am J Prev Med. 2000;18:99–101.
