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This chapter discusses the following topics: health promotion, components of health promotion interventions, the planning process for health promotion, the stages of developing and implementing health promotion programmes, and the selection of education and communication methods. Health promotion practitioners differ in the goals they prioritize, some emphasizing empowerment, others behaviour change. Many people may feel most comfortable carrying out health education activities but can nearly always begin to take some actions on the other components which, if unattended, will diminish the impact of health education activities. There is a growing body of evidence on how to implement effective health promotion interventions, and access to this evidence is getting easier. By ensuring that we disseminate the results of our own interventions we can contribute to developing practice.

This chapter summarizes the conclusions and recommendations from the Task Force on interventions to reduce the initiation of tobacco use, to increase tobacco use cessation, and to reduce the exposure to environmental tobacco smoke (ETS). To reduce tobacco use initiation, the Task Force recommends increasing the unit price for tobacco products, mass media education campaigns, and community mobilization. To increase the cessation of tobacco use, the Task Force recommends increasing the unit price of tobacco products, mass media campaigns, healthcare provider reminder systems, and reducing out-of-pocket client costs for effective cessation therapies. To reduce exposure to ETS, the Task Force recommends smoking bans and restrictions.

Economic evaluation is increasingly used to provide a formal, explicit and transparent framework for informing decisions about allocating public funds in the health care sector. By utilizing economic evaluation in the field of public health, it is possible to address questions about the efficiency of allocating resources to fund interventions aimed at improving public health. Economic evaluation of medical interventions and programmes within the health care sector typically utilizes a framework that aims to maximize health outcomes subject to the health sector budget constraint (an ‘extra welfarist’ perspective). This chapter discusses whether this extra welfarist normative framework can be extended to the evaluation of public health interventions, which may have objectives other than health maximization, and may operate across multiple sectors and budget constraints. The extensions to the framework that would enable intersectoral comparisons and a consideration of equity are considered, as well as frameworks used in other areas of policy evaluation (e.g. cost-benefit analysis based on conventional ‘welfarist’ normative principles). The chapter considers how the current elements of economic evaluation — such as statistical analysis of individual patient data, systematic review, evidence synthesis, and decision-analytic modelling — can be applied to evaluate public health interventions with the view to informing policy. Methods for valuing health outcomes are considered in order to determine the need to move beyond the quality adjusted life year (QALY), and to reflect concerns about equity, and the determinants of health and health inequalities. Methods for evaluating the opportunity costs of allocating resources from multiple sectors to a particular intervention are examined, with a view to calculating the net benefits of alternative interventions. The chapter concludes by considering whether methodological standards for the economic evaluation of public health interventions can be established.

This chapter explores the economics of obesity prevention, particularly the available evidence on the cost-effectiveness of interventions and how the economic credentials for obesity prevention might be developed. It begins with a discussion of the contribution that the discipline of economics can make to an understanding of obesity prevention, explaining the separate but related tasks of description, prediction, and evaluation. Using these concepts, the chapter then explores what is known about the economics of obesity prevention. First, the depth and quality of the available economic literature on obesity is reviewed, and then Australia is used as a case study to illustrate the application of economic methods to describe the disease burden and to evaluate options for change.

Once a particular intervention—a program or policy—has been identified, sound planning techniques can ensure that the program is implemented effectively. This chapter focuses on action planning—that is, planning for a defined program or policy with specific, time-dependent outcomes compared with ongoing planning that is a regular function within an organization. The chapter is organized in five main sections, designed to highlight ecologic frameworks, give examples of behavioral science theories that can increase the likelihood of carrying out effective interventions, review key principles of planning, outline steps in action planning, and describe important aspects of coalition-based interventions.

Targeted interventions to improve population health have long been a feature of public health practice in high-income nations. Area-based interventions focused on improving the health of deprived communities have been a particularly important part of government policy since 1997. Such an approach has coincided with an increasing recognition of the role of ‘context’ in shaping individual health outcomes. The idea that risk factors for poor health and health inequality are not just properties of the individual but are also properties of neighbourhoods, schools, workplaces, and other environmental settings, is a welcome one. However, the challenge for researchers, practitioners, and policy makers is to populate a sparse evidence base for the effectiveness of environmental interventions targeted at specific communities. Drawing on the evaluation of a ‘natural’ community experiment to improve diet in Glasgow — the Glasgow Superstore Project — this chapter outlines some of the challenges of generating evidence for the effectiveness of area-based strategies for heath improvement.

This chapter presents a selected overview of the latest evidence for population approaches for increasing physical activity and reducing sedentary behaviour in different population segments (e.g., children, adolescents, young adults, mid-life adults, and older adults). It considers this evidence within a social ecological context. Emerging issues and directions in the field are also presented.

This chapter reports on the effectiveness of interventions to increase the use of both universally recommended and targeted vaccines. The first section summarizes Task Force conclusions and recommendations on interventions to increase delivery of universally recommended vaccines for children, adolescents, and adults. The next section summarizes Task Force conclusions and recommendations on interventions to increase delivery of targeted vaccines to adolescents and adults.

Complex interventions are widely used in the health service, in public health practice, and in areas of social policy that have important consequences for population health, such as education, transport, and housing. They present a number of problems for evaluators, in addition to the practical and methodological difficulties that any successful evaluation must overcome. In 2008, the Medical Research Council (MRC) published revised and updated guidance to help researchers and research funders recognize and adopt appropriate methods. This chapter summarizes key messages for the evaluation of public health interventions, and discusses some of the issues that have been raised since the guidance was published.

Communities have been highlighted as key settings for obesity-prevention interventions. Community-based obesity-prevention interventions can target individual behaviour, e.g., through the provision of information, advice, support, and feedback at a group or personal level. These interventions can also target the environment of a community, sometimes through policy changes, so that healthy changes can be made more easily. This chapter provides an overview of the issues and challenges in developing and implementing community-based obesity-prevention intervention programmes. It briefly discusses the quality of available evidence, describes current community-based initiatives and the challenges in designing and managing them, and discusses the nature of the evidence required to inform policy and practice.

The first part of this chapter summarizes the conclusions and recommendations from the Task Force for preventing skin cancer by reducing exposure to ultraviolet (UV) radiation. It argues that available evidence is insufficient to determine the effectiveness of interventions to promote informed decision making (IDM). The second part of the chapter summarizes the Task Force's conclusions about IDM interventions.

Natural experiments occur when policy or the forces of nature conspire to produce environments where variations in exposure to health-promoting or health-damaging environments are ‘naturally’ allocated. This might include changes to housing provision, recreational facilities, supermarkets, or transport infrastructure. They are important as they provide an opportunity to evaluate the effects of the wider determinants of health in real-world settings where randomized controlled trials (RCTs) are not feasible. This chapter explores the relationship between the built environment and health behaviours. In particular, it focuses on the challenges and opportunities for evaluating interventions that have manipulated some aspect of the environment either directly or indirectly for health gain.

This chapter summarizes some of the conclusions and recommendations that were published in the report Public health: ethical issues in November 2007. The context to the public health debate is set out in the first section, and the ‘stewardship model’ is presented and the role of evidence is considered. This model outlines the legitimate goals and constraints of liberal states in pursuing public health measures. The next section describes the ‘intervention ladder’, which is a tool that helps use of the stewardship model in practice. It enables an assessment of the acceptability of different interventions in terms of their level of intrusiveness and evidence that is required. The final section considers the case of obesity, which illustrates the role of both the stewardship model and the intervention ladder in policy and practice. The discussion emphasizes the need to consider in particular the situation of vulnerable groups such as children and the socio-economically disadvantaged, and underlines that public health issues concern not only tensions between the individual and the state, but also require consideration of the role of third parties such as industries.

An experimental study is the standard method for evaluating the effectiveness of a health or medical intervention. In such a study, a group of people will be exposed to an intervention and then compared with another group (a control group) who have not been exposed, or with a group who had a different intervention. There are situations in which an experimental approach may not be feasible, ethical, or practical, but, when possible, well-designed controlled experiments provide reliable evidence on the effectiveness of interventions and inform the policies and practice of health promotion. This chapter discusses different experimental designs, explores their strengths and weaknesses, and determines how the most appropriate design might be chosen in light of the many unique features of health promotion interventions. It shows that well-conducted randomized controlled trials (RCTs) are a valid and important way of evaluating health promotion interventions.

This chapter presents a conceptualization of the causes of population obesity, discusses the implications of this conceptualization for public health interventions, and reviews empirical work that has attempted to address obesity treatment and prevention in entire populations. Youth interventions have been delivered primarily through schools. Adult interventions have used heterogeneous delivery modes. All have relied heavily on educational messages encouraging greater physical activity and a more healthy diet. The overall outcomes of these interventions are thought to be very modestly positive, with the strongest results seen in programmes for children that have high physical activity requirements. Unfortunately, the sizes of the overall effect seen in these studies are considerably smaller than the rate of increase in population obesity.

This chapter summarizes the conclusions and recommendations from the Task Force on interventions to increase physical activity using three types of approaches: informational, behavioral and social, and environmental and policy. To increase physical activity using informational approaches, the Task Force recommends community-wide campaigns and point-of-decision prompts. To increase physical activity using behavioral or social approaches, the Task Force recommendations include school-based physical education, individually-adapted health behavior change programs, and social support interventions in community settings. To increase physical activity using environmental or policy approaches, the Task Force recommends the creation of or enhanced access to places for physical activity combined with information outreach activities, and point-of-decision prompts.

This chapter aims to describe all the main interventions that are believed to promote smoking cessation, show why statements about effectiveness will always require semi-quantitative judgements that go beyond the current ‘hard’ evidence, and give estimates of effectiveness based on that evidence. It includes population level interventions such as tax increases, and clinical interventions such as use of nicotine replacement therapy. The chapter also presents a model describing how smoking cessation interventions work. It begins with examination of why developing and implementing smoking cessation interventions is such a major public health priority.

A central challenge for public health is to articulate and act upon a broad definition of public health—one that incorporates a multidisciplinary approach to the underlying causes of premature death and disability. To implement an evidence-based process within this framework, numerous program and policy options become apparent. Identifying and choosing among these options are not simple, straightforward tasks. After options are identified, priorities need to be set among various alternatives. This chapter is divided into four main sections. The first describes some broad-based considerations to take into account when examining options and priorities. The next section outlines analytic methods and models that have been applied when setting clinical and community priorities in health promotion and disease prevention. The third part is an overview of the concepts of innovation and creativity in option selection. The final section describes the development and uses of analytic frameworks in developing and prioritizing options.

Medical ethics, as it has developed across the last twenty-five years, has concentrated almost entirely on clinical ethics. It has focussed on the ethically acceptable provision of healthcare to individual patients, assuming that healthcare is like a consumer good. But there are serious and difficult questions about the tensions between the rights and interests of individuals, and the rights and interests of communities. Public health provision is a public good and can be provided for some only by providing it for many. Clean air, water, and freedom from infection are not consumer goods, and there is little to be achieved by pretending that they are. A convincing ethics of public health therefore needs to draw on political philosophy and its long tradition of considering the limits of just compulsion, and to think through which public health interventions may or must be provided on a compulsory basis.

Economic evaluation can show health promotion interventions in their true light — as a valuable source of investment in health in comparison with traditional health care. This chapter touches on the theory behind finite resources, the need for systems of allocation, and the value of optimization of benefits within limited resources. It then goes on to look more practically at the major issues that are encountered when measuring costs and benefits, dealing with uncertainty and the difficulties that surround transferring results from one location to another. Finally, it presents a cost-effectiveness case study of a malaria-prevention intervention in Malawi, and discusses some of the more common debates in the field.