April 6-12 is National Public Health Week. In accordance with Monday's theme of "Raising the Grade," highlighting the need for more effective community health initiatives, as well as the week's overall theme of Healthiest Nation 2030, we present this article, adapted from Chapter 7 of the latest edition of Jonas and Kovner's Health Care Delivery in the United States, 11th Ed., edited by James R. Knickman, Ph.D. and Anthony R. Kovner, Ph.D.

Acute and infectious diseases are no longer the major causes of death, disease, and disability in the United States. Today, chronic diseases—coronary heart disease, cancer, and asthma—are the nation’s leading causes of illness and death. But much of the growing burden of chronic disease is preventable, owed to Americans’ unhealthy habits and behaviors.

Tobacco Use


Tobacco use causes more preventable deaths and diseases than any other behavioral risk factor, including 443,000 premature deaths from several forms of cancer, heart, and lung disease (U.S. Centers for Disease Control and Prevention). Nearly one in five adults still smokes, with the highest rates (29%) among members of low-income populations. Each day, more than 3,000 children and teens become new smokers, and 30% of those young people will become addicted to tobacco. Furthermore, public health and tobacco control experts are concerned that the availability and marketing of electronic cigarettes (e-cigarettes) may reverse recent declines in youth tobacco use initiation and tobacco addiction by reglamorizing smoking and igniting lifelong nicotine addiction.

Alcohol Use and Misuse


About 5% of the U.S. adult population meets the criteria for alcoholism or alcohol dependence, and another 20% engages in harmful or risky drinking. Alcohol misuse is most common in young adults and excessive alcohol use among U.S. college students remains a problem with college students. Alcohol misuse accounts for approximately 80,000 deaths and more than 2 million years of potential life lost a year (U.S. Centers for Disease Control and Prevention).

Physical Activity and Sedentary Lifestyle

watching tv

The health risks associated with physical inactivity and sedentary lifestyle are numerous. They include heart disease, type 2 diabetes, stroke, hypertension, osteoarthritis, colon cancer, depression, and obesity. National guidelines recommend at least 60 minutes of moderate-to-vigorous physical activity every day for children and teens, but the majority of young people do not meet this goal. Sedentary behaviors are independently linked to higher risk for obesity, diabetes, and other chronic health problems among adults, even those who are physically active and consume healthy diets.

Engagement in physical activity helps to maintain healthy bones, muscles, joints, and weight, and it is also associated with positive psychological benefits. Physical activity has been shown to reduce feelings of anxiety and depression and promote feelings of well-being.

Diet and Nutrition

junk food

Four of the 10 leading causes of death—coronary heart disease, some cancers, stroke, and type 2 diabetes—are associated with an unhealthy diet. The majority of studies suggest that people consuming diets that are low in fat, saturated fat, transfatty acids, and cholesterol and high in fruits, vegetables, and whole grain products containing fiber have lower rates of morbidity and mortality from coronary artery disease and several forms of cancer. Moreover, dietary change has been found to reduce risks for many chronic diseases, as well as for overweight and obesity.



As poor dietary habits and physical inactivity have become endemic, national obesity rates have soared. Nearly 70% of all American adults are overweight or obese—up from 12% just one decade ago. This trend is alarming, given the strong links between obesity and many chronic diseases. More alarming is the prevalence of overweight and obesity among children and adolescents (ages 6 to 19), which has increased significantly over the past three decades. Like adults, overweight youth are at risk for coronary heart disease, hypertension, certain cancers, and even type 2 diabetes early in life.

Making Healthy Changes

Although physician advice can be a powerful catalyst for health behavior change, it's not enough on its own to prevent bad health habits listed above. The future of the US healthcare system demands a focus on teaching communities the skills required to replace unhealthy habits with healthy alternatives. Americans must learn not only why but also how to make changes in their home, work, and social environments to assist them in successfully establishing and maintaining new behaviors that will keep them healthy.