Evidence-based public health interventions for policy makers identified

Government policies that make healthy foods more affordable, improved sidewalk, street and land-use design to encourage physical activity, and bans on public, workplace or residence smoking are among 43 effective public health strategies identified in an American Heart Association statement.

The statement is being published in Circulation, an American Heart Association journal, and is based on researchers reviewing and grading more than 1,000 international studies of diet, physical activity and anti-tobacco public health interventions.

"Policy makers 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,'" said Dariush Mozaffarian, M.D., Dr.P.H., chair of the statement writing group. "We have compiled an evidence-based menu of effective interventions for policy makers, stakeholders and the public based on the results of numerous scientific studies."

Examples of successful interventions include:

• School and workplace interventions, such as school garden programs, increased availability and types of playground spaces and equipment, structured physical activity breaks during class or work hours and comprehensive wellness programs.
• Economic incentives to make healthy foods more affordable, strategies to discourage consumption of less healthy foods, higher tobacco taxes to reduce use and funding for prevention programs.
• Direct mandates and restrictions that limit certain nutrients in foods (e.g., salt, trans fat), restrictions on advertising and marketing of foods/drinks to children and restrictions on public, workplace or residential smoking.
• Local environmental changes, such as better access to supermarkets near homes, walking-friendly neighborhoods, better integration of residential, school, business, and public areas and greater access to recreational sites.
• Media and education campaigns with sustained and focused messages to increase eating specific healthy foods or to reduce smoking.

In addition to identifying the 43 evidence-based interventions in these six categories, the researchers also identified several that were either ineffective or needed more study.

For example, there isn't enough research to conclude whether nutritional labeling or icons on food packages and menus -- widely used or being considered in countries such as the United States, United Kingdom, Mexico and India -- encourages healthier eating. Also, there was not strong evidence that local accessibility to fast food restaurants or small convenience stores negatively affected dietary habits or weight.

"As a society, we must implement evidence-based, cost-effective public health interventions without delay -- we now know they work. New initiatives and partnerships are needed to translate this knowledge into action," said Mozaffarian, who is also co-director of the Program in Cardiovascular Epidemiology and associate professor of Medicine and Epidemiology at Brigham and Women's Hospital, Harvard Medical School and the Harvard School of Public Health in Boston, Mass.

Less than one percent of Americans meet the American Heart Association criteria for ideal cardiovascular health, and poor diet, sedentary lifestyles and tobacco use are the leading causes of preventable disease.

Co-authors are Ashkan Afshin, M.D., M.P.H.; Neal L. Benowitz, M.D.; Vera Bittner, M.D., M.S.P.H.; Stephen R. Daniels, M.D., Ph.D.; Harold A. Franch, M.D.; David R. Jacobs Jr., Ph.D.; William E. Kraus, M.D.; Penny M. Kris-Etherton, Ph.D., R.D.; Debra A. Krummel, Ph.D., R.D.; Barry M. Popkin, Ph.D.; Laurie P. Whitsel, Ph.D. and Neil A. Zakai, M.D., M.Sc. Author disclosures are on the manuscript.