Health promotion in perspective.

Our emphasis in the past has been on disease prevention rather than health promotion. This emphasis served us reasonably well when morbidity was high throughout society and when interventions at the community level were able to achieve massive reductions. It is not faring as well now that the major shared environmental determinants of disease have been controlled. The present situation calls for changes in individual health-related behaviour and individual clinical interventions to achieve comparable progress. As difficult to win as collective commitments to community-level interventions have been, compliance in a free society by often unmotivated persons in numerous individual instances of decision making in daily life is even more difficult. Health promotion offers the promise of a quantum leap in improving the health status of the community by participating in behaviour perceived as not only responsible but appropriate and desirable, providing positive reinforcement rather than anxiety-provoking caution. Favourable social trends, such as physical conditioning and dietary changes may be encouraged through media interventions. There are biological limitations to this approach, however. Many healthful practices confer little benefit on large groups of people and a few may be harmful to selected groups. Vigorous promotion of weight reduction and obesity control, for example, may lead to profound dissatisfaction with body image and to severely self-destructive behaviour among those prone to eating disorders such as anorexia, bulimia, and obsessive eating. Health promotion activities may fit well with social trends but their adverse potential can be aggravated because failure to comply can be penalized by peer disapproval in a way that disease prevention strategies usually are not.(ABSTRACT TRUNCATED AT 250 WORDS)