Good intentions aside, public health strategies vary in effectiveness

Some of the most widely promoted public health interventions are not necessarily the most effective.

For example, there isn’t enough research to conclude whether nutrition labels on food packages and calorie counts on menus encourage healthier eating, said an American Heart Assn. scientific statement published online Aug. 20 in Circulation.

“It’s a little surprising the evidence wasn’t that strong, considering how much attention [they have] gotten,” said statement chair Dariush Mozaffarian, MD, DrPH.

The AHA report, which was written by a group of 13 internists, pediatricians and public health professionals, highlights 43 population-based strategies that improve diet, increase physical activity and reduce tobacco use. It also identifies interventions with less-robust evidence on their effectiveness.

The report found that effective approaches include health warnings on cigarette packages, policies that make nutritious food more affordable and improving sidewalk design to encourage physical activity (link).

“The idea was, with evidence in hand, we could make sensible decisions rather than trying shotgun approaches [to improve the nation’s health], some of which might” not work, said Dr. Mozaffarian, associate professor in the Dept. of Epidemiology at the Harvard School of Public Health in Boston. “Policymakers should now gather together and say, ‘These are the things that work. Let’s implement many right away and the rest as soon as possible.’ ”

The report’s authors focused on population health, in part, because even modest shifts in the public’s behaviors substantially can alter health outcomes and disease risk. They examined studies published between 1985 and 2012 on interventions in six areas: media and educational campaigns; labeling and consumer information; taxation, subsidies and other economic incentives; school and workplace approaches; local environmental changes; and direct restrictions and mandates.

They examined how the approaches changed patients’ health-related knowledge, behaviors, risk factors (such as blood pressure level) and clinical endpoints, including myocardial infarction. Changes in knowledge alone were not considered sufficient to merit evidence of efficacy. The group didn’t evaluate the feasibility of implementing the interventions or their cost-effectiveness.

Researchers also reviewed how health care systems can contribute to changing public behaviors. One recommendation is developing efficient electronic approaches to monitor diet and physical activity, similar to how physicians record blood pressure in electronic health records and track an individual’s levels.

“We know what works,” Dr. Mozaffarian said. “What we need now is action.”