MCLEROY ET AL. RESPOND

Abstract

We wish to thank Rabin for observing that “[h]ealthy aging begins with the fetus, not the adult.” Clearly, community-based public health programs must take into account health and health-related issues throughout the life span and focus on strengthening communities to support the health of all age groups. We will respond to several inferences that might be drawn from Rabin’s letter. First is the implication that health comes from participating in lifestyle programs. Second is the notion that educating children is the pathway to good health. Third is the implication that our approach allows individuals to comfortably and permanently “change.” Our view is that communities are more than mere settings for delivering individually oriented lifestyle change and health promotion programs. Instead, we believe that (1) many of the social forces that produce health and illness are experienced within communities (whether geographic communities, communities of identity, or relational communities); (2) communities are important resources for addressing health and healthrelated issues; (3) substantive, sustainable improvements in population health require addressing the social forces that produce illness, including social and economic disparities; and (4) building and strengthening communities is an important outcome of public health activities, irrespective of their effects on health status. As a result, we think that the delivery of direct services to individuals and participation in programs are only 2 of the numerous and varied goals of health promotion programs. Educating children (and adults) is important for every society. Nonetheless, health education in the narrow sense of conveying information about the benefits and costs of behaviors is a limited approach to addressing the present and future health needs of communities. To effectively advance the health of children, we need to better ensure safe and healthy environments, access to quality health care, smoke-free schools, enforcement of policies on motor vehicle restraints, and development of effective drug and violence prevention strategies. Moreover, we would suggest that in controversial societal issues, for example, adolescent pregnancy, when there is no consensus about who is to blame for the problem and who is responsible for the solution, our society tends to choose educational strategies over strategies that address more fundamental causes. Certainly, change—be it societal or individual—is uncomfortable. Creating a healthy society is not about seeking comfort or permanence, although sustainability of our efforts is an important goal. Rather, creating a healthy society is about seeking social justice and contributing to a peaceful and equitable world.