In the past five years, I have had the privilege of traveling to all the continents of the world (except Antarctica), to talk about health promotion. I normally provide a report on the state of the art and science of our field, usually focusing on program prevalence and research results. By now, I am no longer surprised that I often learn more about health promotion in the US when I am overseas, because the questions I am asked force me to look at health promotion in the United States from a new perspective. During the last year, the most common question I have heard is "With so much research supporting the health and financial impact of health promotion, why isn't health promotion part of the medical and business mainstream?" I still don't know the answer to that question, but I have concluded that now is the time to build health promotion into the national agenda.

What does this mean? We have to decide, but for starters it means making health promotion procedures reimbursable, much like surgical or pharmaceutical treatments. It means increasing the HEDIS requirements of HMO's to include a wide range of health promotion treatments. It means securing a few billion dollars from the tobacco settlement for health promotion programming and research. It means making health promotion an issue in the upcoming presidential election. Maybe we need a new National Institute of Health, the National Institute of Health Promotion. It probably means building a stronger sense of collaboration among the various health promotion organizations, and perhaps even merging some of them. What else does it mean? You have to tell me. We probably need to get together in some forum to first brain storm, then shape ideas into a strategic plan. Please tell me what changes we need to make to build health promotion into the national agenda.  Do we need changes in government policy related to health promotion, the scientific infrastructure supporting health promotion, HEDIS requirements for health maintenance organizations, or government regulations on business?  What other changes are necessary in what other areas?

Am I being unrealistic in thinking we can finally build health promotion into the national agenda?  I don't think so.  Consider the following:

• We have an aging population that will bankrupt the Medicare system if alternative ways are not discovered to keep people healthy. Research efforts are in place to determine if a Dean Ornish type heart disease reversal program is a cost effective method for Medicare to treat heart disease.
• During the past decade, we have extracted all the extraneous administrative dollars possible from the medical care system and the major insurers are expecting to raise medical premiums more than 10% in the year 2000. Keeping people healthy and out of the hospital seems to be one of the few ways to avoid further huge cost increases.
• Probably more important from a business perspective, productivity enhancement is becoming a huge business priority. In the past year, I have asked scores of business executives "How much more productive is a person who is physically and emotionally able to work?" The most common response is 100%. Health promotion can change a person in these ways, and if their productivity increases only 1%, it will more than pay for any health promotion program. Preliminary research in absenteeism reduction alone has shown returns averaging more than four to one.
• When I was in graduate school, I was the only one who ever uttered the word "health promotion" and no one seemed to know what it meant. Now, at dozens of well respected schools, health promotion has been a serious area of study for over a decade.

We now know that health promotion is not easy and its not cheap; we needed professionally trained people to run programs.  Behavior changes last only as long as programs are in place, and we get what we pay for. We can actually reverse heart disease with an intensive and expensive Dean Ornish program, or we can help someone lose and regain 5 pounds with a cheap one-shot program.