It makes little sense to expect individuals to behave differently from their peers; it is more appropriate to seek a general change in behavioural norms and in the circumstances which facilitate their adoption.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 102

Measures to improve public health, relating as they do to such obvious and mundane matters as housing, smoking, and food, may lack the glamour of high-technology medicine, but what they lack in excitement they gain in their potential impact on health, precisely because they deal with the major causes of common disease and disabilities.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 101

The current social, occupational, and national inequalities in health will not be much influenced by health education, for they reflect the way that societies are organized. We already know what is desirable; the obstacles to its achievement, which prevent the majority from having what some already enjoy, are substantially economic, industrial, and political.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 105

In preventive medicine the prospect of personal benefits to health provides only a weak motivation to accept a change, since it is neither immediate nor substantial, and an individual's health next year is likely to be much the same, regardless whether that person accepts or rejects the proferred advice.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 105

The high-risk preventive strategy ... is a targeted rescue operation for vulnerable individuals.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 95

If a small amount of alcohol slightly impairs a driver's judgement, then the large number of drivers who have had one or two drinks would collectively incur a large excess of accidents, even though none of them individually had an obvious problem, but current policy assumes that this is not the case.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 86

A radical approach aims to remove the underlying impediments to healthier behaviour, or to control the adverse pressures. The first or medical approach is important, but only the social and political approach confronts the root causes.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 100

The problems of sick minorities are considered as though their existence were independent of the rest of society. Alcoholics, drug addicts, rioters, vandals and criminals, the obese, the handicapped, the mentally ill, the poor, the homeless, the unemployed, and the hungry, whether close at hand or in the Third World - all these are seen as problem groups, different and separate from the rest of their society.

This position conveniently exonerates the majority from any blame for the deviants, and the remedy can then be to extend charity towards them or to provide special services. This is much less demanding than to admit a need for general or socio-economic change.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 96

Mass behavioural changes can be related to changes in opportunity (bicycles instead of walking, then cars instead of bicycles), in price (turkey, once the food of aristocrats, now the ordinary man's Christmas dinner), in convenience (refrigerators favour soft margarine rather than butter, and food can now be stored without salting), in fashion (modern Western disapproval of plumpness in women), and in pressures from opinion leaders and health educators (smoking in developed countries) opposed by those from manufacturers and advertises (smoking in developing countries).
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 108

... socio-economic deprivation includes a whole constellation of closely interrelated factors, such as lack of money, overcrowded and substandard housing, living in a poor locality, worse education, unsatisfying work or actual unemployment, and reduced social approval and self-esteem. In turn this constellation of deprivations leads to a wide range of unhealthy behaviours, including smoking, alcohol excess, poor diet, lack of exercise, and a generally lower regard for future health.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 127

In a democracy the ultimate responsibility for decisions on health policy should lie with the public. At present that does not happen.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 124

The primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 129

... political effort should be focused on three broader components of deprivation, each of which profoundly influences health and where some progress would be possible even in the face of economic inequalities: these are education, housing, and unemployment.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 128

Much can be done by individuals themselves to improve their own health prospects, but whether or not they will actually take such action depends substantially on economic and social structures for which governments are responsible.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 120

The so-called free market system, which for a time now dominates political and economic thinking, implies freedom for wealth-generators at the price of a severe curtailment of freedom for the rest of the population.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 119

To enable people to make and to implement healthy choices requires information and facilities which must be centrally funded and provided.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 122

In public and governmental perception the harm from polluted air tends to be exaggerated, whereas that from poverty is underestimated.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 121

... the fact that in many countries smoking has become much less prevalent does not make it any less risky to the individual smoker but it does reduce the potential benefit from an anti-smoking campaign.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 75

People are generally motivated only by the prospect of benefit which is visible, early, and likely. Health benefits rarely meet these criteria; they may be real, but they are likely to be delayed and to come to only a few of those who seek them.
Happily this does not mean that health education has no chance, but only that its acceptance depends on attractions other than a distant hope of better health. The anti-smoking effort has achieved a radical change in public attitudes, for a habit which a few years ago was considered normal is now widely disapproved of, even by smokers. The motivation for this change has been more social and psychological than medical, because a person who gives up cigarettes is immediately rewarded by enhanced self-esteem and social approval. Thus unhealthy behaviour involves a usually small and remote risk of damage to health but also an immediately perceptible damage to self-respect.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 13

... a preventive measure that brings large benefits to the community offers little to each participating individual.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 12

A population strategy of prevention is necessary where risk is widely diffused through the whole population.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 14

... high-risk strategy, in which efforts are focused on those individuals who are judged mostly likely to develop disease.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 13

The scale and pattern of disease reflect the way that people live and their social, economic, and environmental circumstances, and all of these can change quickly.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 1

The essential determinants of the health of society are thus to be found in its mass characteristics: the deviant minority can only be understood when seen in its societal context, and effective prevention requires changes which involve the population as a whole.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: vii

... the idea of a sharp distinction between health and disease is a medical artefact for which nature, if consulted, provides no support.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 6

... the prevention of deaths is only likely to involve net economic advantage if it applies to children or young adults, and beyond the age of about 50 the economic outcome is increasingly negative as applied to preventive measures which extend survival.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 4

... a risk which has not materialized within the individual's own experience is unlikely to be regarded seriously.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 22

... society is not merely a collection of individuals but is also a collectivity, and the behaviour and health of its individual members are profoundly influenced by its collective characteristics and social norms.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 62

Social norms rigidly constrain how we live, and individuals who transgress the limits can expect trouble. We may think that our personal life-style represents our own free choice, but that belief is often mistaken. It is hard to be a non-smoker in a smoking milieu, or vice versa, and it may be impossible to eat very differently from one's family and associates. Social norms set rigid limits on diversity, and those wishing to persuade minorities to be different from the majority would do well to remember the rooks.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 56

... risk factors predict disease but they do not necessarily cause disease or predict benefit from an intervention: low income is associated with more illness, but health may not be improved by winning a large sum of money on the football pools.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 75

... moderate and achievable change by the population as a whole might greatly reduce the number of people with conspicuous problems. Conversely, it is hard to find any examples where deviation has been suppressed and everyone conforms to the 'happy mean'. The abolition of deviance, whilst leaving the population as a whole unchanged, seems not to occur: the forces for diversity prevent it.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 68

... the burden of ill health comes more from the many who are exposed to a low inconspicuous risk than from the few who face an obvious problem. This sets a limit to the effectiveness of an individual (high-risk) approach to prevention.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 27

... a large number of people exposed to a small risk may generate many more cases than a small number exposed to a high risk.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 24

In summary, the purpose of risk assessment is not to categorize individuals according to a test result nor even as to their overall risk, but rather to identify those who can be helped, or helped most, by preventive action.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 42

Policy guidelines for screening to assess risk

1. There should be no screening without adequate resources for advice and long-term care.

2. Selective screening and care are more cost effective than mass screening.

3. The purpose is to assess reversible risk - not risk factors
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 34 - 38