The rising cost of health care: can demand be reduced through more effective health promotion?

The cost of health care continues to rise in the face of an apparently insatiable demand. Unless the actual need for health care can be reduced to manageable levels, the financial burden will probably become economically unacceptable. Although some illnesses are unavoidable, others that are largely due to unhealthy lifestyles are preventable. Circulatory diseases, diabetes and some cancers, which are major causes of morbidity and mortality in western societies, are strongly linked to physical inactivity, psychological stress, unhealthy eating, obesity and smoking. There is ample evidence that promotion of healthy lifestyles, including physical activity, healthy eating and non-smoking, are effective for the primary and secondary prevention of these diseases. Although there are examples of successful public health programmes that have encouraged more healthy lifestyles and reduced the burden of disease, we need to be much more effective in putting theory into practice. In order to improve the health of the nation and to prevent the economy being overwhelmed by the increasing demand for health care, we need a change of mindset from a consumerist approach to an acceptance of personal and corporate responsibility for more healthy lifestyles. Widespread collaboration among health care agencies, private and public utilities, the entertainment industry and the communications media will be necessary in order to provide the necessary incentives for lifestyle changes.