Catalyst, coach, or legislation

Recognition and treatment of disease remain important responsibilities of pediatricians, but increasingly we've come to understand that significant improvements in child health in the 21^st century will require changes in behavior that are as pivotal as advances in drugs and technology.

There is no question that pediatricians accept responsibility for influencing the behaviors of parents and children and reducing the behaviors that put children and adolescents at risk, but what is the best way for us to do that? Some studies demonstrate that when physicians make a recommendation, patients are more likely to change behaviors. For example, adult patients who received physician advice to quit smoking and were given written material supporting that recommendation were more likely to report trying to end their habit.² It logically would follow that those types of strategies could be helpful in motivating parents to help promote healthier behaviors in their children, too.

Dr Tellerman's article reminds us, however, of the tension between medical practice and broader approaches to improving the health of a population. Laws requiring seat belts and bicycle helmets have reduced death and injury; increasing the cost of cigarettes results in reduced use of tobacco, particularly among teens; and a recent study in Australia suggested that the population benefits of legislation limiting salt in food would have 20 times the beneficial health impact of providing dietary advice to patients or encouraging the food industry to reduce salt in processed foods.³

Legislation and recommendations from health policy organizations such as the American Academy of Pediatrics and the Centers for Disease Control and Prevention are important allies in enhancing the health of children and of the adults they will become. It is clearly apparent to every healthcare provider, however, that there are opportunities every day in our face-to-face encounters with parents, children, and adolescents to encourage healthy behaviors and discourage behaviors that increase the risk of injury, illness, and shortened lives. The strategies provided by Dr Tellerman encourage us to make the best possible use of those opportunities.

REFERENCES

1. Olshansky, SJ, Passaro DJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2005;352(11):1138-1145.

2. Kreuter MW, Chheda SG, Bull FC. How does physician advice influence patient behavior? Evidence for a priming effect. Arch Fam Med. 2000;9(5):426-433.

3. Cobiac LJ, Vos T, Veerman JL. Cost-effectiveness of interventions to reduce dietary salt intake. Heart. 2010;96(23):1920-1925.