Which changes in the environment (second level from the bottom of the health impact pyramid) make the choice for a healthy behavior the default or easy choice? (Select all that apply.)
A) Iodization of salt
B) Restrictions on smoking in public places
C) Community immunization programs
D) Changing food manufacturing to eliminate trans fats
E) Treatment of hypertension
Ans: A, B, D
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At the second level from the bottom of the health impact pyramid are interventions that change the environment or options available so that making the choice for a healthy behavior is the "default" or easy choice whereas choosing a less healthy option would require a person to spend more time, effort, or money. Examples include food and drug safety, iodization of salt, elimination of trans fats in food, and restrictions on smoking in public places and work sites. Changing food manufacturing to eliminate trans fats, for example, will have a positive impact on the health of the entire population without people having to change their buying or eating habits and would be sustained over time. At the middle of the pyramid are community health interventions such as immunizations that have a long-term protective effect as well as periodic screenings such as colonoscopy. At the level just above the middle of the pyramid are clinical interventions such as treatment of hypertension, hyperlipidemia, and diabetes.
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