Closing the ecological gap: the public/private dilemma.

Numerous health behavior theories and models address human and environmental factors that affect health status. Although ecological models have called for multilevel intervention strategies, all too often health professionals remain unsure which levels of intervention to target: individual, institutional/organizational, community, public-policy or some combination of these. The decision is often influenced by general societal perceptions of how much control individuals have over health risks. These perceptions, in turn, influence health professionals' own perceptions. The question raised here is how do these perceptions of how public or private a health issue is affect the intervention levels we target? Frequently intervention levels are discussed as if they exist on a continuum, with private individual interventions at one end, and societal policies and laws at the other. This article offers a 'public/private health matrix' based on two axes, one representing individual rejectability of health risks, the other showing how publicly or privately supplied or regulated these risks are. The 10 leading causes of death and two childhood illnesses in the US are used to demonstrate how the matrix might help analyze the public/private nature of different health risks and risk-reducing strategies, and to demonstrate how such distinctions may influence the levels of intervention health professionals target.