Community Prevention Programs

Feet, Forks, and Fingers

Nearly 2 decades ago, an influential study helped refashion understanding of the “actual causes” of premature mortality and excess morbidity by looking beyond the diseases that are the proximal causes of death to the root causes of those diseases. The study concluded that half of the annual mortality toll in the United States—roughly 1 million deaths—was premature. Further, data suggested that these deaths could be deferred with the modification of just 10 behaviors: tobacco use, dietary pattern, physical activity level, alcohol consumption, exposure to microbial agents, exposure to toxic agents, use of firearms, sexual behavior, motor vehicle crashes, and illicit use of drugs. That list of 10 was, in turn, much dominated by the top 3—tobacco use, dietary pattern, and physical activity level, which alone accounted for nearly 800,000 premature deaths in 1990. More than a decade later, the same 10 modifiable behaviors, dominated by the same 3, persisted as leading causes of both premature death and chronic disease, although progress in tobacco control warrants honorable mention.

More recent research consistently reaffirms the grim toll of lifestyle practices at odds with health but also offers the promise of dramatically turning these circumstances around were we to devise the right means to apply what we know about lifestyle to our health and lives routinely. For example, in 2009, findings from a study of more than 23,000 German adults enrolled in the European Prospective Investigation Into Cancer and Nutrition (EPIC) intervention indicated that only 4 behaviors—smoking, diet, physical activity, and weight control—accounted for a 78% variance in the apparent risk of any serious chronic disease. In this study, individuals with all 4 “healthy behaviors” as compared with those with none had a hazard ratio of only 0.22 (95% CI, 0.17–0.28) for diabetes, myocardial infarction, stroke, or cancer. On average, the presence of just 1 healthy behavior, as compared with none, cut the chronic disease risk in half (hazard ratio 0.51; 95% CI, 0.43–0.60). In 2010, another study found much the same array of associations in a cohort of roughly 5000 adults in the United Kingdom. These and other recent studies offer a consistent take-away message: In whatever reasonable way living healthfully is cataloged and health outcomes are captured, the latter improve when the former is practiced.

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