BOX 4-1

Comprehensive Efforts to Address Public Health Concerns

Highway Safety:

  • Federal government: Safety regulations for new vehicles; highway design and safety regulations; establishment of the National Highway Traffic Safety Administration; state and community grant programs; research funding

  • State and local governments: Highway safety offices; primary enforcement of safety belt laws; alcohol-impaired-driving laws; requirements for licensing and driver education; motor vehicle inspections

  • Public support and advocacy: Citizen advocacy groups (e.g., Mothers Against Drunk Driving)

  • Research

  • Media campaigns

  • Education: Driver education; parent education regarding safety seats


  • Federal government: Airline smoking ban; warnings on tobacco packages; research funding; Surgeon Generals’ reports; establishment of the Office on Smoking and Health

  • State and local governments: Excise taxes, laws that establish smoke-free workplaces and public locations

  • Public support and advocacy: Grassroots efforts to prevent exposure to second hand smoke; community coalitions (e.g., ASSIST)

  • Research

  • Media campaigns

  • Education: School-based programs

NOTE: This box denotes only selected examples of the multiple approaches used to address each public health problem.

SOURCES: IOM, 1999, 2003; Economos et al., 2001.

Parallel and synergistic efforts to prevent adult obesity, which will contribute to improvements in health for the U.S. population at all ages, are also beginning. Grassroots efforts made by citizens and organizations will likely drive many of the obesity prevention efforts at the local level and can be instrumental in driving policies and legislation at the state and national levels (Economos et al., 2001).

A policy analysis by Kersh and Morone (2002) shows that three of the seven common triggers for strong public action in response to a public health problem are beginning to be activated with respect to the U.S. obesity epidemic: social disapproval that shifts the social norm, evidence-based medical research, and self-help movements for overweight and obese individuals. Other triggers that have worked successfully for public health problems such as tobacco, alcohol, and illicit-drug use (a widespread coordinated movement or campaign; fear of problem-related behaviors or re-

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