A recent article in the American Journal of Preventive Medicine¹ details the life of a man named Fred, living in the "Healthy Heart" utopian community called Metaphor City.

Fred begins his day with a fresh fruit breakfast suggested by a free smartphone meal planner prompt (the wireless company is a Healthy Heart co-sponsor). Fred rides his bicycle to work, taking advantage of an alternative transportation incentive from his employer, and rides along pathways recently installed by the municipal department of transportation, another Healthy Heart cosponsor.

A Healthy Heart message, featuring the common look and logo designed by a local advertising agency for all cosponsors' use, fills the billboard outside Fred's office. Fred's employer has renovated space for a small exercise facility and locker room, where Fred showers after cycling to work. Participating Healthy Heart stores and eateries post nutritional labels on shelves and menus to designate heart-healthy foods. Fred's health plan, along with all other major insurers in the area, offers a Healthy Heart premium discount based on points earned at supermarkets and restaurants, so Fred gets points for the veggie wrap he eats for lunch on the way to his doctor's appointment. Points are calculated from bar code data for these products that are captured on Healthy Heart club cards.

Fred parks his bicycle at the doctor's office, another partner in the Healthy Heart initiative. Fred's doctor devotes the visit to Fred's back pain, but a prompt on her tablet computer reminds her to offer Fred free enrollment in a commercial weight-loss program. On his way home Fred cycles to the new neighborhood supermarket, which opened thanks to tax incentives from the city council. A large Healthy Heart banner hangs over the fresh produce aisle, where Fred finds the ingredients for the vegetable stir fry described on his smartphone's meal planner. Metaphor City Elementary School has been serving more nutritious foods and devoting curriculum time to wellness issues. At home, Fred's son talks about training for an upcoming walkathon and suggests that they walk the dog to the new lakeside park. The zoning commission had authorized a local developer to build the park on the grounds of an abandoned warehouse complex.

Wow! A far stretch from most U.S. communities which are not physical activity friendly and do not encourage healthy food choices. Neat; but, is a concerted community-wide strategy like this really necessary for people to change their behaviors and reduce their risk of chronic diseases? And how could an infrastructure of this magnitude (employers, media, wireless service providers, municipal government, grocery stores, restaurants, physicians, and land developers, etc.) ever be established and maintained?

Authors of the previously referenced article argue that, yes, a citizen-centered approach to health promotion that "recognizes that health behaviors are a function of daily living conditions that citizens experience, and not just of their personal decisions or clinical encounters as patients" is necessary to facilitate healthy living. They say that health promotion initiatives undertaken in isolation (like a clinician's advice to lose weight or a public health campaign to eat more fruits and vegetables) can motivate people to change their behaviors, but their ability to take subsequent action is limited by the environment in which they live, work, study, and play. Thus, they believe that health behaviors are not entirely a matter of personal choice.

What do you think about the citizen-centered model? What would it take to develop a well-coordinated systems of partnership among healthcare providers, public health programs, schools, employers, and businesses? Share your thoughts on our Facebook page. 

The Cooper Institute will soon be developing a coordinated program to help healthcare providers counsel their patients on weight management AND then provide web-based tools, resources, and referrals for continued education and support. Funded by the Cancer Prevention Research Institute of Texas (CPRIT), this project will help to build collaborations within Texas communities to facilitate healthy living. Click here to learn more about the CPRIT grant.

¹Woolf, S.H. (2011). Citizen-centered health promotion: building collaborations to facilitate healthy living. Am J Prev Med, 40(1S1), S38-S47.