What Works Good, Better, Best In Health Promotion?

We have been at this for four decades.  We are no longer infants, but we are still adolescents.  We have great ideas and energy; and we are idealists.  We do good work, but we still mess up sometimes.

Programs are established in business, community, clinical, school and commercial fitness center settings. Good health outcomes are consistently achieved and remarkable outcomes are some times achieved. Medical cost reduction is common.

However, we have not reached consensus on the most effective methods. We do not know the most time efficient or cost effective ways to improve health.  We do not know the best combination of programs to reduce medical costs, or enhance productivity.  We DO produce good outcomes;  we just don't know what works best when, where or how. In short we do not know What Works Best.
 
We do have empirical evidence to support what works best in some limited areas.
For example, we know that 300 minutes of talk therapy is optimal for smoking cessation.  More minutes than that does not seem to increase quit rates. We know that a combination of talk therapy plus medication triples success rates over either method by itself.  Emerging research is showing that $200 seems to be the optimal incentive for HRA participation and that the highest participation rates occur when incentive are integrated into the health plans, and the HRA is promoted with strong communication and  strong management support.  We know, of course that a combination of more physical activity plus less food leads to weight loss but we do not know how to motivate people to do either one of those. We are good at reaching the people who make up the core of our field:  white, middle class, well educated, motivated people. We are not so good at reaching people who are young or old, lower income, lower education, ethnically and racially diverse or people in rural settings.
 
The good news, the GREAT news, is that we are going see rapid growth in the size and number of health promotion programs in the next five years in the United States and in the world.  Furthermore, most of our new customers know so little about what we do that they will accept what ever we offer.  The bad or the good news, depending on your perspective, is that unquestioned demand will last only a few more years. If we do not figure out what works best, and build those principles into all of our programs, we will loose this position of high expectations and credibility into which we have worked so hard to move.
 
The 2010 Art and Science of Health Promotion Conference will answer some of the questions about what works best, AND it will ask far more questions than it answers.  Figuring out what works best must be the focus of our field for the next five years.
 
We need to ask ourselves:
What do we know vs. what do we suspect?
Why do we suspect what we suspect?
How do we know what we think we know?

Michael O'Donnell, PhD, MBA, MPH
Editor in Chief, American Journal of Health Promotion
Program Chair, Art and Science of Health Promotion Conference