ethnic group. Health promotion strategies that succeed in one population may not be successful in another. The evidence that older cohorts respond better than younger cohorts is intriguing, but it requires confirmation and explanation. The evidence of differential response by education also needs study: How should interventions be designed to more effectively reach less educated, lower income groups? Racial and ethnic differences in response to interventions need to be identified and explained: Are they due to socioeconomic factors, to differences in the support environment, to particular cultural traits, or to some combination of these factors?


Direct promotion of individual behavior change is only one of the tools available to reduce health disadvantages among particular racial and ethnic groups. The range of possible interventions to achieve such public health objectives includes

  • economic incentives and disincentives linked to health-relevant behaviors;

  • changes in the informational environment—education, product labeling, and regulation of commercial speech;

  • direct regulation through penalties for behavior risky to oneself or others or for organizations that fail to deliver contracted health benefits;

  • indirect regulation through the legal tort system; and

  • deregulatory actions that dismantle legal barriers to desired public health behaviors (Gostin, 2001).

Such measures can be designed to affect personal behavior (through education, incentives, or penalties) or to work indirectly: through modifying the general environment for behavior or through affecting health care providers or other producers of relevant products and services (Sampson and Morenoff, 2001).

Effectiveness of Interventions

Relatively little is known about how interventions affect health differences. In fact, their effectiveness at improving population health, regardless of their effect on differences, is still a matter for discussion. Large-scale community experiments aimed at changing behavior in the population at large (not just among older adults) have been disappointing. Multifaceted community intervention experiments that promoted healthy behaviors have shown some effects, such as those in the 12,866-subject experiment labeled

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