Promoting Healthy Behavior: How Much Freedom? Whose Responsibility? edited by Daniel Callahan. Washington, DC: Georgetown University Press; 2000. 186 pages, paperback, $19.95.

Promoting Healthy Behavior: How Much Freedom? Whose Responsibility? is the product of a 2-year research project to explore the ethical and social dilemmas of health promotion and disease prevention. All the authors of its nine chapters participated in the project.

The most enjoyable aspect of this book is that it challenged, though only temporarily, my smug beliefs about the value of governmental intervention in promoting healthy behavior. This does not mean that I no longer believe in a strong government role, but that the arguments made by the authors were interesting and provocative.

The authors raise important questions: Should government emphasis be on individual health behavior, or on the social and economic context in which behaviors are shaped? Does health promotion really save money, and is this an important question to raise? Can government meddling create a backlash against health-promoting initiatives? Should a downhill skier be encouraged to take a 30-minute walk instead? Can government health promotion money be better spent on reducing poverty and injustice? Does health promotion stigmatize those with the greatest need? Should insurance be punitive toward smokers? If so, what should be done about overweight people, sedentary people, and, oh yes, those pesky downhill skiers?

In addition to a wide range of stimulating and relevant questions, the book is well written and fills an important gap in the health literature.

I might have stopped my book review with the previous sentence if I had not started reading Food Politics by Marion Nestle and Fast Food Nation by Eric Schlosser. These two books drove home the unfair fight that exists between making a profit and promoting health in this country. For example, is it a fair fight when so many products (including a curious breath mint) spend 50 times more for advertising one product than the federal government does to promote good eating habits? Or, that some products spend 1,000 times more? Is it fair that food and drink manufacturers target children by infiltrating fast food and sugary drinks into the public schools? Is it fair when fatty, sugary, and salty foods are associated with toys and trinkets, and when Ronald McDonald is second in name recognition only to Santa Claus? Is there no parallel between the food industry and the tobacco industry when it comes to targeting children with an avalanche of advertising? Is it not relevant that about two thirds of the population is overweight?

With no modesty I must say that the book would have been better balanced if I had been invited to write a chapter strongly supporting more government involvement with health promotion. American adults spend many sedentary hours in front of their computer screens and television sets, receiving countless messages to buy products that promote profit rather than health. That's fine. I believe in capitalism. I believe in freedom. I believe in profit. And I believe Americans should have the right to buy potato chips with gingko biloba if they want to.

I also believe that it is not too much to ask of government to promote health, and to do it a lot more seriously than it has been. If we do, and if it is done well, I believe we will be more energetic, look better, sleep sounder, be stronger, have lower blood pressure and blood glucose levels, and so on. The book left out one question in its subtitle: How much responsibility should the government have? The answer: More!