Scope and Target Population:
This guideline, Primary Prevention of Chronic Disease, outlines the existing evidence for the effectiveness of strategies and programs designed to help adults successfully make essential changes to achieve healthier lifestyles (increased physical activity, improved nutrition, decreased tobacco use and exposure, decreased hazardous and harmful drinking/alcohol use). It also outlines how these programs might be integrated into preventive services in health care systems, which traditionally have focused on early detection of disease or treatment of risk factors rather than preventing the onset of risk factors.

Nearly all individuals would derive measurable benefits from healthier lifestyles; even small improvements across a large portion of the population would have a greater impact than focusing on a small portion of the population that is at the upper end of the risk distribution. Therefore, the target population for this guideline includes all adults (age 18 and older) in the community, irrespective of their utilization of the health care system. Although this guideline focuses on adults, adolescents and children may benefit from many of the components or recommendations in this guideline.

Clinical Highlights and Recommendations:

• Four lifestyle behaviors – adequate physical activity, a diet that emphasizes fruits and vegetables, abstinence from tobacco and avoidance of tobacco smoke, and avoidance of hazardous and harmful drinking – are associated with a decade or more of increased life expectancy. Individuals who adopt this lifestyle, at any age, have significantly lower total mortality rates.
  
• Medical groups cannot be given the sole responsibility for effecting lifestyle changes. There is a growing recognition and understanding of the role that community networks, physical and social environments, and public policy all play in fostering healthier lifestyles.
  
• A broad approach is necessary to achieve and support healthier behaviors in individuals. It requires individual change, health care system redesign, as well as community, employer and payer support.
  
• Health risk assessments are most effective when combined with interventions aimed at risk reduction and support.
  
• Collaborative decision-making and brief, combined interventions are effective in helping motivate and engage patients in healthier lifestyles.
  

Priority Aims:

1. Improve the population health of adults ages 18 and older, through the identification and promotion of healthy lifestyle behaviors.
   
2. Improve the effectiveness of health risk assessments by providing timely feedback, education and other interventions.
   
3. Improve the coordination and integration between the health care system, employers and community-based groups to support healthier lifestyles in adults.
   
4. Create patient-centered health care delivery systems that collaborate with external stakeholders in supporting healthier lifestyles of adults.