PREFACE TO FIRST EDITION

The health promotion field emerged during the second half of the twentieth century as medicine and science became successful in treating infectious diseases with antibiotics, advancing maternal and child health, and improving sanitation practices. These gains significantly improved the quality and quantity of life for all. Yet, now we face the next medical crisis: chronic disease. Medicine and science research have continued to manage disease conditions through a number of procedures, surgeries, and pharmaceuticals. All of these approaches come with a very high cost to the individual through reduced quality of life and economic cost to organizations and the federal government responsible for providing health insurance. At this time, health care costs account for 18.3% of the gross domestic product. This means that the United States spends almost eighteen cents of every dollar on providing health care to Americans. Controlling these health care costs is a continuing priority for the nation. Consider that over 70% of all health care costs are related to chronic disease and that many risk factors for chronic disease are considered modifiable, such as tobacco use, physical inactivity, food choices, and managing stress. These modifiable risk factors are the core behaviors that the field of health promotion focuses on to improve the quality of people's lives and manage rising health care costs.

Changing individual and societal health behavior is a very complex process. Since the 1980s, more research has shown that for individuals to successfully adopt healthy behaviors, social, behavioral, and environmental factors also must be part of the process of change. The healthy choice must be the easy choice in our homes, schools, worksites, and communities. The vision is to live in a country where a culture of health is seen, practiced, and supported throughout the life span.

The unique contribution of this book is to introduce students to the individual and societal forces that have transformed the factors that influence one's health, including social and physical environments, medical advances, personal lifestyle choices, and legislation. The book identifies and discusses the innovative health campaigns, strategies, and policies that are being implemented and enacted to improve health behaviors and practices that ultimately improve the quality of life.

It is my desire that the writings in this book inspire you to either embark on a career in health promotion or, at the very least, provide you with an understanding of the ways in which many disciplines intersect with health promotion, so that whatever discipline you study, you will better understand how your work interacts with the promotion of health. Almost every discipline intersects with the field of health promotion. Further, health promotion professionals do not work in isolation. The nature of health promotion is to work across multiple disciplines to design and develop strategies that use the best knowledge we know and apply it to health behaviors. Table P.1 lists diverse areas of study and identifies the related work of health promotion, whether you study exercise or nutrition science to understand how to advise consumers on health behaviors to improve their health status or if you study communication or marketing to design health campaigns that inform the general public about health risks associated with smoking or drinking and driving or public policy to understand or evaluate how public health policy decreases health disparities by providing consumers with healthful foods or access to affordable health care.

Table P.1 Disciplines and the Relationship with Health Fields

This introductory textbook for health promotion students is designed and written to be distinctly different from other textbooks. It provides readers with an in-depth examination of the forces that have changed our lifestyles and environments over the past century, which in turn have resulted in changes in individual health behaviors that affect the onset of chronic conditions. During this same time frame, there were also considerable medical advances, improving early detection of disease and developing progressive treatments for chronic conditions. These changes are ones that health promoters must understand and address. Ultimately, the framework for the development of social and physical environments that support healthy lifestyle choices will guide the transformation of communities where people are empowered to make healthy choices, so they can live longer lives free of preventable disease, disability, and premature death.

The book is divided into three parts. Part 1, "The Foundation of Health Promotion," introduces the framework of health promotion and provides the student with a number of key terms, models, and trends related to the field. Chapter 2 introduces health behavior change theories that offer constructs on how individuals approach personal behavior change, that is, the essence of health promotion-engaging individuals to actively promote their own health through daily actions such as being physically active or selecting healthy foods to eat. Program planning models (chapter 3) are essential tools to successfully reach large groups of people through social marketing campaigns to interventions to enacting policies to create environments in which people can practice healthy behaviors.

Part 2, "Health Behaviors," describes those actions that promote health and prevent disease. These chapters introduce the short history of how tobacco use, eating, physical activity, and emotional health has evolved as a result of the changes in our social and physical environments. These chapters provide a comprehensive discussion of the health behaviors that influence the onset of chronic disease in our country and how and why these behaviors have changed over time. Chapter 8 highlights the important role clinical preventive services also have in promoting health by monitoring chronic disease development and overall health status. Health promotion professionals are promoting healthful living; hence, the inclusion of preventive services (immunizations and age-appropriate screenings) available through the medical community needs to be understood and promoted.

These health behavior chapters examine how changes in our environment and society over the past several decades have affected behaviors and how those changed behaviors affect health and disease. By understanding the historical perspective of each of these behaviors, health promotion professionals will possess a richer context for their work, understanding that multiple forces have shaped, and continue to affect, the health of individuals and our society. Health behavior change is complex; in order to advance innovative solutions, it is critical that health promoters fully understand the history of these behaviors. Within each chapter, examples of policies and programs that exemplify health promotion in action are provided.

Part 3, "Health Promotion in Action," presents how state and federal governments engage in promoting healthful living for their consumers, what associations and certifications support the health promotion profession, where health promotion is taking place and the job opportunities available for this profession, and closing out with future trends in health promotion as we move through the twenty-first century. There are a plethora of national activities that promote health and prevent disease. The federal agencies monitor health status, provide broad guidelines, conduct research, and fund programs to promote health. Collectively, there are thousands of federal employees who work across disciplines to study or implement new approaches to improve the health of our society.

Chapter 10 discusses the setting where health promotion takes place, which further exemplifies that health promotion is beginning to be seen everywhere, such as in day care centers, schools, colleges, worksites, food stores, retirement homes, and communities. Again, thousands of professionals believe in the vision of a country in which people practice healthy behaviors every day because the healthy choice is the easy choice. Staying current within the discipline will be important after you graduate....