摘要：Health awareness initiatives are a ubiquitous intervention strategy. Nearly 200 health awareness days, weeks, and months are on the US National Health Observances calendar, and more than 145 awareness day bills have been introduced in Congress since 2005. We contend that health awareness days are not held to appropriate scrutiny given the scale at which they have been embraced and are misaligned with research on the social determinants of health and the tenets of ecological models of health promotion. We examined health awareness days from a critical public health perspective and offer empirically supported recommendations to advance the intervention strategy. If left unchecked, health awareness days may do little more than reinforce ideologies of individual responsibility and the false notion that adverse health outcomes are simply the product of misinformed behaviors. Today is not like every other day, or at least it is supposed to be unique. Chances are, today is designated as one of the nearly 200 health awareness days, weeks, or months on the US Department of Health and Human Services’ (DHHS) National Health Observances (NHO) calendar. 1 The health awareness day—to our knowledge first defined by Mulvihill as a “brief exposure, high visibility program designed to stimulate thinking and discussion of certain health risks and issues by large numbers of [people]” 2 (p321)—is an intervention strategy well known to public health practitioners, policymakers, and the public alike. Although the ubiquity of awareness days might be self-evident, data suggest that health awareness days have proliferated over the past four decades ( Figure 1 ). A legislative search revealed that 202 bills have been introduced in the US Congress with “awareness day” in the title since 1973, with 71% of them introduced after 2005. 3 The awareness day has also received increasing attention in the health science literature. A November 10, 2014, PubMed search for entries with “awareness day” or “awareness days” in the title or abstract retrieved 80 results, with the trend in publication volume corresponding with the trend in bills introduced. 4 Open in a separate window FIGURE 1— Trends in attention to awareness days in US Congress and health science literature (1974–2014). Despite the frequency with which awareness days are implemented and written about, relatively little public health scholarship has critically examined the intervention strategy. For example, the 2011 Joint Committee Report on Health Education and Promotion Terminology, which contains a glossary of key terms to the work of the profession, does not provide a definition for awareness or awareness day. 5 In addition, many widely used health promotion textbooks do not discuss the construct of awareness. 6,7 As a result, the public health literature provides little guidance concerning fundamental questions that should be considered before developing and implementing a health awareness day. These include: To what extent have awareness days been evaluated? What strategies should be used to assess their effectiveness? How is the construct of awareness operationalized and measured? Is the awareness day intervention design guided by appropriate theories of health promotion? In this commentary, we synthesize research and scholarship to explore these questions, identify knowledge gaps, and examine the awareness day from a critical public health perspective. Although we touch upon related intervention strategies, such as the awareness week and the awareness month, we primarily focus on the awareness day because it is the smallest unit of intervention and component of which the others are comprised. We contend that the health awareness day has not been held to an appropriate level of scrutiny given the scale at which it has been embraced. It is our intention for this commentary to stimulate dialogue about awareness days—as well as the broader construct of awareness—in the public health community and offer empirically supported recommendations to ensure that the health impacts of this intervention strategy are maximized and measured.
