National Academy of Medicine

Chronic Disease Prevention: Tobacco, Physical Activity, and Nutrition for a Healthy Start: A Vital Direction for Health and Health Care

By William H. Dietz, Ross C. Brownson, Clifford E. Douglas, John J. Dreyzehner, Ron Z. Goetzel, Steven L. Gortmaker, James S. Marks, Kathleen A. Merrigan, Russell R. Pate, Lisa M. Powell, and Mary Story
September 19, 2016 | Discussion Paper

Smoking, obesity, inactivity, and excess intakes of added sugar, saturated fats, and salt are major contributors to the rates of chronic disease in the United States, and the prevalence and costs of chronic diseases associated with those modifiable behaviors account for a growing share of our gross domestic product. Our medical system has evolved to treat people for diseases that result from these behaviors rather than to prevent the diseases. However, as described in the following sections, the prevalence of the diseases associated with the behaviors greatly exceeds the capacity of our medical system to care for people who have them. Furthermore, few providers are trained to deliver effective behavioral-change strategies that are targeted at the risk factors to prevent their associated diseases.

There is a need for broader preventive solutions that focus on the social and environmental determinants of chronic diseases. A variety of policy and environmental changes have begun to improve those health-related behaviors through deterrents, such as tobacco taxes, or through product reformulation, such as reduction in the sodium content of processed foods. But the contributions of tobacco use, inactivity, and poor diet to chronic-disease rates remain high, and efforts to prevent and control the co-occurring epidemics of obesity, cardiovascular disease, diabetes, and cancer must be sustained. The success of these efforts requires multicomponent strategies implemented in multiple sectors and settings. Many of the strategies are being undertaken. In the sections that follow, we expand on the magnitude of the challenge, point to successful initiatives that are underway, and identify the most promising opportunities. Perhaps the biggest challenge is in learning how to implement what we know needs to be done.

About the Vital Directions for Health and Health Care Series

Vital DirectionsThis publication is part of the National Academy of Medicine’s Vital Directions for Health and Health Care Initiative, which commissioned expert papers on 19 priority focus areas for U.S. health policy by more than 100 leading researchers, scientists, and policy makers from across the United States. The views presented in this publication and others in the series are those of the authors and do not represent formal consensus positions of the NAM, the National Academies of Sciences, Engineering, and Medicine, or the authors’ organizations.
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Suggested Citation

Dietz, W. H., R. C. Brownson, C. E. Douglas, J. J. Dreyzehner, R. Z. Goetzel, S. L. Gortmaker, J. S. Marks, K. A. Merrigan, R. R. Pate, L. M. Powell, and M. Story. 2016. Chronic Disease Prevention: Tobacco, Physical Activity, and Nutrition for a Healthy Start: A Vital Direction for Health and Health Care. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. doi: 10.31478/201609j


Disclaimer: The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved.