Priorities for health promotion

The objective of this paper is to describe a framework in which the causes of ill health (measured ultimately by reduced duration and quality of life) can be identified, and the cost-effectiveness of alternative means of reducing this ill health can be ranked. In the first part of this paper, an economic perspective for determining the burden of illness is explored. A framework for calculating avoidable life years lost which can exploit available data is described. In the next two sections, the potential use of this approach is illustrated. Some calculations on the burden of different diseases are presented in the first of these sections. In the next part of the paper, some examples of calculating avoidable disease are discussed. The work needed to elaborate the initial framework is indicated. Health promotion seeks to increase the duration and quality of life by changing health behaviour. In the fourth section of this paper, some of the available data which could be used to examine current levels of, and trends in different aspects of life styles are reviewed. The fifth section contains a brief review of some of the available literature about the most cost-effective means of reducing the burden of illness through health promotion. Finally, some concluding comments are made about the further work which could be undertaken to test the robustness and efficiency of this framework, and how it could be extended and refined.