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05/18/2010

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This is great, Dave -- I look forward to seeing (and hopefully being a part of) many thought-provoking discussions here.

Indeed, a welcome opportunity to be a part of thought provoking discussions around the import of population health. I heartily agree that it deserves to be center stage in any discussions about what kind of health care system we need. My first comment and thought...I worry that the depth and reach of the social environmental context effect on lifestyle choices is often overshadowed by the personal responsibility context. I hear this not only from the general public, but see it in the way educational programs are often designed to "correct" individual behaviors when there is good evidence that societal corrections (no smoking laws, etc.) do more to affect change. So much of the argument that focuses so strongly on personal responsibility is antithetical to what I consider a fuller population health perspective yet that is most of the work I see. What am I missing? What efforts do folks see happening, what new research efforts are underway, how can we best add balance so that the public is aware of the strong role public policy can play in helping people make healthy choices? (maybe this is seminar and not blog material?)

> Roberta, thanks for the thoughtful comment. I think the issue of personal responsibility and environmental context with regard to behaviors is one of the most important in our field, and yes, could be a seminar or whole course. For now, to your comment that "so much of the argument that focuses so strongly on personal responsibility is antithetical to what I consider a fuller population health perspective yet that is most of the work I see. What am I missing?", I'd say that there is a growing movement to influence the environmental context (see MN's State Health Improvement Plan menu of interventions: https://www.health.state.mn.us/healthreform/ship/rfp/SHIPRFP_Section3.pdf) to complement efforts that have a more individual focus. The best evidence available to us shows, of course, that both are important. As Brownell and colleagues assert in their recent article (Health Affiars March 2010 p.379), "The challenge is to combine personal and collective responsibility approaches in ways that best serve the common good." We'll look forward to exploring on the blog how this challenge is being addressed across diverse communities and sectors.

Exactly the kind of cite I was looking for. Thanks Dave. (Guess I should be more careful as I review those T of Cs.)

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