Some Strategies to Reduce Risk 103 governments should find ways to encourage people to use resources more appropriately even if the finance is not provided by govemment. The evidence presented in this chapter will facilitate this process WHAT STRATEGIES CAN REDUCE RISKS TO HEALTH? WHO defines the health system to include all actions whose primary intent is to im prove health(5) and some activities that improve health fall outside this definition Exam- ples include reductions in poverty, and improvements in housing and education, which may well reduce exposures to some types of risks but are not primarily designed to improve health. This chapter is concerned mainly with interventions that have the primary intent of proving health. Some interventions, however, are difficult to categorize strictly using this definition. One set that has traditionally fallen within the remit of public health covers improvements to water and sanitation. Many water and sanitation programmes fall outside the health por folio, and clearly such improvements do have considerable amenity value outside health. However, clean water and improved sanitation are considered in this chapter because their attributable burden of disease is so significant. It must be noted, however, that althor they improve health, many of their benefits are not readily incorporated into a cost-effec- tiveness framework and should be considered when comparing them with other types of A number of strategies have been used to reduce health risks that are seen as modifi- able. They can be categorized broadly as interventions that seek to reduce risks in the popu lation as a whole, and those which target individuals within the population. The former include intervention by governments through legislation, tax or financial incentives; engi neering solutions such as the introduction of safety belts in motor vehicles or the provision of piped water; and health promotion campaigns targeting the general public. The latter clude strategies to change health behaviours of individuals, often through personal inter- action with a health provider; and strategies to change the behaviours of health providers, particularly in the way they interact with their clients Genetic screening is a valuable tool for some diseases associated with the risk factors described in this report, but individual genes are not susceptible to m Genetic screening is not considered further in this chapter. RISK REDUCTION AND BEHAVIOUR Many risk reduction strategies involve a component of behaviour change. Even engi neering solutions, such as the provision of piped drinking-water, will not result in health improvements unless people are willing to use the new source. Social scientists argue that behavioural change first requires understanding(6, 7).4 Anumber of individual preferences or characteristics influence how people translate understanding into health behaviours, including how averse to health risks individuals are and how they value possible future health decrements compared with other competing choices in their lives such as wealth and lifestyle. These preferences are influenced by information and the influence of adver- Perceived risk "is the subjective assessment of personal disease risk, based on an indi viduals interpretation of epidemiological and other types of data. There may be a difference In the case of addiction, individuals can struggle to change their behaviours despite recognition of the harmful effects to themselves and others( 8)Some Strategies to Reduce Risk 103 governments should find ways to encourage people to use resources more appropriately even if the finance is not provided by government. The evidence presented in this chapter will facilitate this process. WHAT STRATEGIES CAN REDUCE RISKS TO HEALTH? WHO defines the health system to include all actions whose primary intent is to im￾prove health (5) and some activities that improve health fall outside this definition. Exam￾ples include reductions in poverty, and improvements in housing and education, which may well reduce exposures to some types of risks but are not primarily designed to improve health. This chapter is concerned mainly with interventions that have the primary intent of improving health. Some interventions, however, are difficult to categorize strictly using this definition. One set that has traditionally fallen within the remit of public health covers improvements to water and sanitation. Many water and sanitation programmes fall outside the health port￾folio, and clearly such improvements do have considerable amenity value outside health. However, clean water and improved sanitation are considered in this chapter because their attributable burden of disease is so significant. It must be noted, however, that although they improve health, many of their benefits are not readily incorporated into a cost-effec￾tiveness framework and should be considered when comparing them with other types of health interventions. A number of strategies have been used to reduce health risks that are seen as modifi￾able. They can be categorized broadly as interventions that seek to reduce risks in the popu￾lation as a whole, and those which target individuals within the population. The former include intervention by governments through legislation, tax or financial incentives; engi￾neering solutions such as the introduction of safety belts in motor vehicles or the provision of piped water; and health promotion campaigns targeting the general public. The latter include strategies to change health behaviours of individuals, often through personal inter￾action with a health provider; and strategies to change the behaviours of health providers, particularly in the way they interact with their clients. Genetic screening is a valuable tool for some diseases associated with the risk factors described in this report, but individual genes are not susceptible to manipulation at present. Genetic screening is not considered further in this chapter. RISK REDUCTION AND BEHAVIOUR Many risk reduction strategies involve a component of behaviour change. Even engi￾neering solutions, such as the provision of piped drinking-water, will not result in health improvements unless people are willing to use the new source. Social scientists argue that behavioural change first requires understanding (6, 7). 4A number of individual preferences or characteristics influence how people translate understanding into health behaviours, including how averse to health risks individuals are and how they value possible future health decrements compared with other competing choices in their lives such as wealth and lifestyle. These preferences are influenced by information and the influence of adver￾tising and marketing. “Perceived risk” is the subjective assessment of personal disease risk, based on an indi￾vidual’s interpretation of epidemiological and other types of data. There may be a difference 4 In the case of addiction, individuals can struggle to change their behaviours despite recognition of the harmful effects to themselves and others (8)