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Book Review: Prescription for a Healthy Nation: A New Approach to Improving Our Lives by Fixing Our Everyday World, Tom Farley and Deborah A. Cohen. Boston, MA: Beacon Press, 2005, 296 pp

One of the challenges in the professional preparation of masters of public health (MPH) students is to provide them with essential competencies in the field of health behavior. Indeed, this challenge may also be applicable to students earning a doctoral degree that pertains to public health. Thus, an introductory course is essential. As part of this course, we have recently required our MPH and doctor of public health students to read this book authored by Drs. Farley and Cohen. The feedback received from students has been overwhelmingly positive. Indeed, the text has made teaching a far more efficient and engaging process. Four reasons appear to account for the apparent success of this text in the classroom. First, the authors have written a textbook that concisely and incisively applies an ecological approach to changing health behaviors. Rather than articulating an elaborate set of propositions about ecological models, the authors provide students with an extensive and recent history of effective approaches to health promotion that are based on relatively humble and modest changes in the environment. Their use of vignettes and their focus on well-known disease outcomes (e.g., diabetes, heart disease, and injuries) makes the presentation of their evidence highly accessible, even to students who have never taken a course in health behavior (including students who may have been quite skeptical or pessimistic about the field). Their case for using an ecological approach is built from a compelling chapter that clearly suggests to students that cognitive theories of behavior change have not been efficacious and, at best, such theories may have implications for programs that reach only small segments of the entire population. In the subsequent chapter, the authors eloquently and persuasively illustrate the principles of Geoffrey Rose regarding shifting the mean risk of an entire population as opposed to focusing only on the tail of the curve (i.e., those most at risk; Rose, 1992). After reading this chapter, students are left with the unmistakable impression that public health is indeed about achieving population-level change and that this goal is best met by changing multiple aspects of the physical, legal, economic, and social environments that define the lives of millions of Americans. Although the concept of an ecological approach to behavior change is clearly not new to the field, it is wonderful to have the approach described in everyday language for introductory students. Second, the textbook carefully prepares students for their exposure to an ecological approach by establishing that health and health care are largely unrelated entities. Given the American mindset that health care is the road to health, the first two chapters of this book strategically demonstrate the fallacy of this thinking. These two chapters are especially well cited and include classic lessons that are key to the public health repertoire, for example, John Snow’s “masterstroke,” The contribution of Edwin Chadwick to public health, and the Greek legends of Asclepius, Panacea, and Hygiea, as well as the top 10 actual causes of death as described by William Foege, Michael McGinnis, and Ali Mokdad. Indeed, these chapters are enjoyable to read because they succinctly suggest that the same public health actions that saved a nation from the throes of infectious disease can now be applied to save us from the ever expanding burden of chronic disease. That the authors are both physicians adds to the credibility of the argument that chronic disease will not be substantially averted by pumping endless resources into the U.S. health care system. In fact, these physicians provide compelling evidence that our current health care system is broken and that the answers to societal health lie in shifting the U.S. “average” of health behaviors away from unhealthy toward healthy behaviors, not in bureaucratic or technological fixes to the health care system.