This graphic does a very good job outlining the relationship between behavior and the clinical risks and endpoints that are so prevalent in our disease care system. While I applaud the display of this connection in one of our leading clinical journals, partly out of my hope that frontline care providers are better informed about the significance of primary prevention efforts as an avenue to prevent or delay the onset of chronic conditions, the image shows only the "tip of the iceberg".
What lies beneath the surface? What drives poor dietary habits, physical inactivity and smoking?
Many might suggest that these behaviors are the result of a lack of personal motivation to make healthy lifestyle choices. However, personal motivation is part and parcel of a much larger picture of personal support structures, or lack thereof. These include individual resources (financial, physical, psychological, emotional, skills, information), the family, community, workplace and society at large.
It is because of this collection of interwoven determinants of behavior, and behavior change, that Sustainable Health System has invested in developing tools that enable primary care practices to better understand the "ecology" of the individual and to help build infrastructures and links to resources that would be beneficial to the health and well being of those at risk.