Reviews
"Prescription for a Healthy Nation is the best book about public health I've
read in years. If you want to know why it seems so hard to hard to eat right,
be active, stop smoking, and do all those other good things, read it right away.
Farley and Cohen compellingly explain how our society makes it so easy to do things
we know are not good for us, and so hard not to. Their important message: it is
not enough just to take personal responsibility for our own actions-we also have
to work for changes in society that make it easier for everyone to stay healthy."
Marion Nestle, author of Food Politics: How the Food Industry Influences Nutrition and Health
"A brilliant call to action for both individuals and the nation, Prescription
for a Healthy Nation offers a clear and compelling roadmap for improving our lives."
Kelly Brownell, author of Food Fight: The Inside Story of the Food Industry, America's Obesity Crisis,
and What We Can Do About It
"Prescription for a Healthy Nation is highly readable, interesting and informative.
More important, it offers the reader an approach to good health that is balanced
and practical. Risks are placed in proper perspective and attention is given to
the relative contributions of our own behaviors and the external influences and
environment that promote or hinder good health."
Jeffrey Koplan, former Director, Centers for Disease Control and Prevention
From JAMA: Journal of the American Medical Association:
In Prescription for a Healthy Nation: A New Approach to Improving Our Lives by Fixing Our Everyday World, Tom Farley, MD, and Deborah A. Cohen, MD, detail perhaps the best solution
to this nation's health care woes. Despite spending more than one trillion dollars
on health care annually, more Americans than ever develop chronic diseases such
as diabetes mellitus, obesity, and chronic pulmonary disease. Health care professionals
and public policy architects are struggling to increase access to medical care,
improve quality, and contain rising costs. Nevertheless, the best efforts of our
physicians and politicians seem to fail.
Fortunately, in their well-written and readable book, Farley and Cohen provide
realistic solutions. After assessing the behavioral and environmental factors
that contribute to chronic disease in America, the authors propose sensible interventions
to help curtail our modern epidemics. Farley and Cohen effectively argue that
we must not focus all our efforts on the development of treatment guidelines for
those who already have chronic medical conditions such as hypertension, AIDS,
and diabetes mellitus. Rather, to prevent chronic medical conditions and create
a healthy nation, we must change our social and physical environment.
The first chapter, "The Wrong Remedy", challenges readers to think beyond treatment
guidelines, prescription drug plans, and access to health care. The authors first
describe a patient with almost unlimited access to health care through an insurance
plan that pays 100% for office visits and hospitalizations. She pays only $10
for three-month supplies of prescription drugs. Unfortunately, she has diabetes,
hypertension, and obesity. The authors then ask readers if this patient should
be considered healthy and whether more access to health care or prescription drugs
would improve her health. Next, they consider the findings of articles published
in JAMA on "Actual Causes of Death in the United States". The articles attempt to trace the underlying contributory factors to the causes
of death recorded on death certificates. The articles conclude that about half
of all deaths are caused by behaviors such as smoking cigarettes, drinking alcohol,
consuming high-fat diets, and gun violence. Farley and Cohen then assert that
the "major reason why we Americans die early is that we behave in an unhealthy
way. It is what we do that makes us sick, not lack of access to medical care."
Their argument is rational and supported by evidence.
The remaining chapters are equally thought provoking, as the authors develop
a plan to change the unhealthy aspects of our environment. They use examples of
previous successful public health initiatives to demonstrate how throughout history
preventive measures have had greater impact on our health than treatment of illness.
Since poor lifestyle choices and unhealthy behaviors contribute so heavily to
today's epidemics, we clearly have numerous opportunities for prevention. To end
our modern epidemics, disease prevention must include changes in the social acceptability
of unhealthy behaviors and restriction of access to high-fat diets, cigarettes,
alcohol, and guns. Such changes may require new rules, laws, and a different physical
landscape.
To limit access to the major factors contributing to development of chronic illnesses,
the authors suggest several measures, such as taxes on junk food, indoor smoking
bans, and demolition of abandoned houses that can be used for illegal drug sales.
They also suggest changing the portrayal of unhealthy behaviors in advertising,
movies, television, and video games. Building safe parks for walking and ensuring
that grocery stores make healthy food choices more available might also be part
of the blueprint for a healthy nation. The authors acknowledge that some of their
ideas are controversial and may even be considered radical, but they implore readers
to fight for change regardless of political obstacles.
Overall, Prescription for a Healthy Nation is an excellent book that successfully introduces a new approach to today's
epidemics. Farley and Cohen have built logical arguments supported by evidence.
Prescription for a Healthy Nation delivers an important message that should be shared with everyone.
Brian C. Reed, MD, JAMA, June 8, 2005
From Environmental Health Perspectives:
Much of our daily news is devoted to health care crises. Spiraling health
care costs, which currently consume one-seventh of the U.S. economy, are mostly
devoted to treating a modern epidemic of preventable chronic conditions such as
obesity, diabetes, lung cancer, and heart disease; however, treatment of these
chronic conditions does little to prevent future cases. Preventive interventions
designed to educate people about the health risks of overeating, tobacco use,
alcohol abuse, and sedentary lifestyles have had limited success in modifying
behaviors and have not translated into a logical reversal in the prevalence of
these chronic diseases.
In Prescription for a Healthy Nation, Tom Farley and Deborah Cohen suggest solutions for reversing this trend and
preventing new cases by changing the social and physical environment. In "The
Leading Causes of Health," the authors argue that the environment is a powerful
force in influencing human behavior, although changing and redesigning the environment
to promote health is not necessarily a "new approach." The sanitation and hygiene
revolution of the 19th and 20th centuries--the greatest success of modern public
health practice--was largely carried out by constructing sewers, mandating solid
waste disposal and access to clean water in cities, and other interventions to
prevent the spread of infectious agents. The success of these preventive measures
lies in the fact that the benefits affect the entire society. However, according
to the authors, many current preventive interventions that attempt to reduce risk
through education tend to ignore the aspects of our environment that encourage
risky behavior, such as the overabundance of high-fat junk food and pervasive
advertising of alcohol and tobacco. In addition, preventive education has largely
targeted individuals at high risk such as people with high-fat diets who are thus
at a higher risk for having a heart attack, while neglecting the much larger population
of individuals with moderate- or low-fat diets who have a lower risk for heart
attack. By absolute numbers, more lower-risk people will suffer heart attacks
than high-risk individuals; therefore, consuming less fat will reduce everyone's
risk. The authors propose a return to this "curve-shifting" approach to prevention
that encourages everyone to improve their health behavior; they substantiate these
arguments with examples from public health and cognitive psychology research,
historical and current events, and personal anecdotes.
In "Curve Shifters," Farley and Cohen identify four modifiable components
that influence our health environment or "healthscape": a) accessibility of healthy (e.g., fruits and vegetables) and unhealthy items
(e.g., tobacco); b) physical structures that promote or endanger health (e.g., guardrails) and
neighborhood designs that discourage crime or promote physical activity; c) social structures that influence the acceptability of our health behaviors
(e.g., bans on indoor smoking); and d) the popular media that influences our behavior through advertising and the
broadcasting of influential images in movies.
In the final section, "Healthscaping America," solutions are proposed for
altering the environment to promote health, for example, mandating the display
of fresh fruits and vegetables at checkout counters in supermarkets and convenience
stores and banning the sale of junk food in schools and the advertising of alcohol
on television. Workplaces can encourage employees to take exercise breaks, and
neighborhood streets can be designed to encourage walking and bicycling for travel
and recreation. The authors concede that these are not complete solutions and
that these proposals will generate controversy and be viewed both as radical and
as an excuse for personal irresponsibility by policymakers and businesses with
a financial stake in their implementation. However, throughout the history of
public health, interventions such as sanitation and indoor smoking bans that were
once deemed radical are now commonly accepted as a responsibility of the state.
Farley and Cohen present these provocative ideas in a clear and highly readable
manner with contemporary examples that address the urgency of this crisis. This
book is an instructive resource for scientists, policymakers, community health
advocates, and anyone with an interest in improving the health of our society.
Rudolph Rull, September 2005
From the New York Times:
"Sure, we can buy more "left ventricular assist devices," which cost $210,000
per patient installed, or buy Erbitux for colon cancer, at $17,000 per month of
treatment. But as a wise new book, "Prescription for a Healthy Nation," argues,
you get more bang for the buck when you promote healthier lifestyles - fighting
obesity, cigarette smoking and the like.
Raising cigarette taxes saved far more American lives, for example, than
an army of neurologists ever could. In the same spirit, I'd like to see a French-fry
tax. And imagine the health gains if we banned potato chips and soda from schools."
Nicholas Kristof, Medicine's Sticker Shock, The New York Times, October 2, 2005
From Kirkus Reports:
Despite America's wealth and frequent medical advances, we're not doing so well,
say Drs. Farley and Cohen. Our infant mortality rate is too high, and people die
too young. With this thesis, the doctors embark on an exploration of the many
wrongheaded ways in which Americans pursue health - too much emphasis on cure
and not enough on prevention. To understand the phenomenon further, they investigate
four features of society - the accessibility of consumer products, physical structures,
social structures, and media - and how they contribute to the leading causes of
death in our nation (smoking, physical inactivity, drinking, unhealthy eating,
risky sexual behavior, and injuries). Then, they propose real-world solutions
that have to do with changing political policy: Heavily regulate tobacco advertising
and distribution. Invest in parks and tax food based on fat content. Raise alcohol
prices through taxes. The authors claim that citizens possess only the illusion
of choice (such as the ability to choose a brand of beer), while larger choices
are made by corporate powers - beer is widely available and easily purchased by
a determined teenager. A fascinating and informative read for those frustrated
with America's state of health or interested in how regulation could improve well-being.
From the New Orleans Times Picayune:
We know that exercising regularly and eating the right kinds of food will
help us stay healthy. So why is it that so many Americans struggle with obesity
and a host of other chronic ills? Just take a look around.
"There are many features of our world that make it difficult to be healthy,"
said Dr. Tom Farley, a public health expert and co-author of a new book, "Prescription
for a Healthy Nation" (Beacon Press, $24.95). From junk food at every turn to neighborhoods without safe places to walk,
play or bike, our environment can defeat our best efforts to stay healthy, Farley
and co-author Deborah Cohen say. They suggest that the answers to the ever-growing
rates of obesity and chronic diseases such as heart disease and diabetes lie not
in modern medicine or health education programs, but in making environmental changes
that make it easier for people to do things that are good for them, such as eating
healthful foods and getting exercise.
They're not the first to make such an argument. Throughout the country, health
advocates are calling attention to environmental conditions they say have made
it difficult to lead healthy lifestyles. In the fight against childhood obesity,
for example, school vending machines laden with high-calorie snack foods have
become a prime target. Legislators throughout the country, including
Louisiana
, have considered or instituted bans.
Such measures have met with resistance from some representatives of the food
and beverage industry, who make the case for personal responsibility when it comes
to food consumption. It's not the food, but overconsumption that causes obesity,
they say.
Farley, who is chairman of community health sciences at Tulane University
School of Public Health and Tropical Medicine, agrees with the importance of taking
responsibility for how one lives. But he also makes the case for societal responsibility
to protect the public health. "I don't think there's a conflict between societal
responsibility for building a healthy environment and personal responsibility,"
he said. "We need both."
Farley and Cohen, a natural scientist at the RAND Corp., set out to show
that, when it comes to improving people's health, environmental changes have proved
effective time and again. "If you look through history, we've gone through a transition
in several areas of health," Farley said. "It starts with the idea that we're
going to educate ourselves out of a problem, then switches around to an environmental
change approach. And every time we've done that, we've had huge increases in health.
What we're doing in this book is just trying to demonstrate that pattern and show
that you can apply that to the health problems we have today."
Car safety, Farley said, is a prime example. For decades, the National Safety
Council held that car crashes were caused by bad drivers and the only way we were
going to solve this problem was to create safer drivers, Farley said.
"We were going to educate our way out of the problem. But it didn't work,"
he said. "It took a different mindset to say drivers can be bad, but cars can
help contribute to the problem and roads can help contribute to the problem, so
we'll fix those. We'll build safer roads and safer cars. Nowadays everyone assumes
that it is natural for the federal government to regulate the car industry to
make sure cars are safe. Once people see what these environmental changes can
do, and see that they are not personally intrusive, people can be very enthusiastic
about them."
.........
Siona Lafrance, New Orleans Times Picayune, Thursday, May 26, 2005
