Whose behaviour needs to change? Key factors in an effective response to the burden of non-communicable disease

Behaviour change is important in improving population health, but it is predominantly the behaviour and public health approach of governmental and civil society bodies that needs to change. The major health concern for the twenty-first century globally is the steadily growing burden of non-communicable disease. The sanitary revolution of the nineteenth century was based upon a universalist approach led by government and enacted across civil society. Despite the development in the late twentieth century of powerful and successful health promotion approaches to health improvement, there has been undue reliance on approaches based on encouraging individual behavioural change and reflecting the consumerist construct of 'lifestyle'. But successful change initiatives remain both possible and necessary and there are six identifiable key factors that should be taken into account in the development of population health programmes.