May 16, 2012

If prevention is such a great idea, why don’t more people practice it?

Dr. Barbara K. Rimer

Dr. Barbara K. Rimer

Since at least the ancient Greeks, humans have extolled the virtues of prevention. But if prevention is such a good thing, why will more than 420,000 people in the U.S. die of lung cancer this year, most as a result of cigarette smoking? Why are 66 percent of us in America now overweight or obese, with much of the world not far behind? Why have only one-third of teenage girls in the U.S. received all three recommended doses of HPV vaccine, proven to prevent cervical and other cancers?

Prevention is a great thing, but it’s not easy. Changing behavior is challenging, especially addictive behaviors and those that are targeted through marketing and manipulation of our environments (think junk food). It is not enough to change individuals–although that’s important. We also must change policies and environments.

Removing trans fats from restaurants and vending machines, making stairways attractive and adding signage to cue people to use them, and not providing sugary soft drinks are some of the ways we can re-engineer environments for health. Increasing educational attainment would make people healthier, but that’s even more controversial.

As Trust for America’s Health, Surgeon General Regina Benjamin and others have recommended, we must change the way we live–how we eat, play and work–to become a healthier society. (See

Prevention may be challenging, but it’s not impossible. Millions of people have stopped smoking, lost weight, reduced heavy drinking and taken up exercise. Prominent voices for prevention, such as Thomas Frieden, MD, MPH, director of the U.S. Centers for Disease Control and Prevention (CDC), argue that we should restructure policies and environments to make the healthier choice the easy one. (Easier is probably more accurate.) Some major food companies have agreed to lower sodium in food in an agreement led by the Robert Wood Johnson Foundation (RWJF).

Many schools are putting the health back into their lunches. Alice Ammerman, DrPH, is working with a local school to use texting as a strategy to enable adolescents to select healthier lunches. (See an article in UNC’s University Gazette at Communities across the U.S., working with RWJF-funded Active Living By Design, based in our School, are re-engineering their communities to facilitate exercise. (See We must do more–much more.

Stories in this issue paint a picture of the exciting work our faculty members and students are doing to prevent diseases and decrease risk factors. The breadth of work is amazing and awe-inspiring. We are making a difference. It will take a lot more people working together consistently, intentionally and on a large scale to make the even larger changes needed in the U.S. and around the world.

Let’s get moving even faster! Our future is at stake.


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