Fifty Observations About the Health Promotion Discipline: Tributes, Cautions and a Call to Action (Part One)

In observance of having worked for going on five decades in the health promotion profession, this editorial shares fifty observations about the state of our field. In part one, I offer these first twenty five observations that focus on societal trends that have shifted how we frame our work and the movement from wellness to well-being. I reflect on why the wellness term fell out of favor, the roots of the well-being term and attendant definitions of health promotion. Seminal professional text books, popular readership books and key studies that have informed the health promotion discipline are reviewed. I summarize several conundrums that need solving for and conclude with calls to action for health promotion professionals.

Why Not Offer Routine Screenings for Brain Health?

The merits of routine health screening for cancer and cardiovascular diseases are well established given the strong evidence that early detection can lead to effective interventions. Health systems, insurance providers and public health agencies have incorporated systematic approaches to ensuring that preventive screenings for hypertension, hyperlipidemia and cancers are encouraged, readily accessible and reimbursed. Workplace wellness programs intent on containing preventable healthcare costs have also sponsored age- and risk-adjusted health screenings, often including financial incentives to encourage same. Should we also screen for brain health? Is early detection of value for a condition with no proven treatment or cure? This editorial reviews the pros and cons of testing for cognitive decline, Alzheimer's and related dementias and suggests that with nearly every country in the world getting proportionally older, promoting brain health could emerge as a key intrinsic motivation for promoting healthier lifestyles. I conclude that a person-centered approach to deciding about testing is needed given uncertain evidence connecting health behaviors to cognitive decline.

The Stare Decisis Doctrine and Total Worker Health®: Prior Precedent and Continuous Improvement in Health Promotion

What advantages are accruing to companies that intentionally integrate their health, safety and mental well-being initiatives? "Total Worker Health®", using the definition from the National Institute of Occupational Safety and Health (NIOSH), is: "Policies, programs and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being." The NIOSH WellBQ is an individual level questionnaire that asks employees about their perceptions related to their quality of work life, circumstances outside of work, supervisor support and physical and mental health status. Total Worker Health® related research funded by NIOSH is intended to "build the scientific evidence base necessary to develop new solutions for complex occupational safety and health problems." This editorial argues that there is an unreconciled tension in the health promotion field relating to the evidence needed to prioritize individual vs social responsibility for health. The NIOSH Total Worker Health^® and organizational health scorecards are discussed in the context of honoring the need to balance both lifestyle and environmental oriented interventions.

A Rose is a Rose is a Rose: Reviewing Definitions for and Reimbursement for Health Promotion, Lifestyle Medicine, Behavioral Medicine, Preventive Medicine and Population Health

How do the definitions between health promotion professions differ? Should the shift from using the term wellness to greater use of the well-being term challenge us to explain how our profession improves how people appraise their lives as a whole? After all, achieving well-being is a challenge as relevant to clergy, politicians, artists and entertainers as to health professionals. Successful organizations are keenly attentive to how they differentiate their services so as not to get lost in a sea of like competitors. The American College of Lifestyle Medicine has recently defined lifestyle medicine as a medical specialty delivered by certified clinicians. In contrast, the Society of Behavioral Medicine suggests that virtually any degree holder may be qualified to provide disease management and prevention services. If improved health is one of the surest ways to improve well-being, do we need to more clearly define the health promotion profession's value proposition? How should definitions about differences between professions influence reimbursement differences between professions?

External Validity and Worksite Wellness: Lessons From China and Illinois

This editorial describes recent randomized controlled trials of worksite wellness interventions and argues that fidelity to intervention designs should be contingent on careful consideration of internal and external validity. A China based hypertension management study which achieved impressive outcomes across 60 workplaces using a comprehensive approach is contrasted with the traditional wellness practices employed in other randomized controlled trials conducted in America. Why studies with negative findings receive more media and professional scrutiny than studies with positive findings is discussed. Three reasons are posited for why bad is stronger than good when it comes to capturing attention. Adoption of new evidence is discussed along with what health promotion professionals can do to advance best practices by considering adoption as an ongoing process.