The second public health revolution: a critical appraisal.

This paper presents a critical reaction to the Surgeon General's recent report and recommendations on American health. Entitled Healthy People, the report has been described as providing impetus for a "second public health revolution." Our analysis leaves us less than enthusiastic. We first summarize the Report, noting its heavy emphasis on lifestyle. We then compare its tenets with those of the nineteenth century public health revolution. The Report recognizes social and economic conditions as significant factors in determining health but fails to incorporate this recognition in its policy recommendations. Instead, it places the burden of its recommendations on the reform of individual behavior. We explain this focus in terms of the continued centrality of the ideology of individualism and its collective counterpart, social and political pluralism. We then examine the ways in which these ideologies act on the Report and we suggest why the proposals they shape are unlikely to be successful.