Carrots, Sticks, and Promises: A Conceptual Framework for the Management of Public Health and Social Issue Behaviors

of these deaths are premature and attributable to lifestyle and environmental factors (UC Berkley Wellness Letter 1997). Advances in biomedical sciences, mass immunization, and sanitation have resulted in a decrease in the incidence of infectious diseases (Matarazzo 1984), so that the health status of the population in economically developed countries now has less to do with acute illness than with lifestyle issues such as excessive drinking, unhealthy diet, or the use of tobacco products (Walsh et al.1993). Influencing lifestyle can do more to increase the health of the population and lower the cost of health care than can treatment of illness. In this article, a conceptual framework is proposed for the management of public health and social issue behaviors. The article relies on education, marketing, and law as its three primary classes of strategic tools. These tools will be considered with respect to specific targets and specific public health or social issues for which the targets may or may not have any motivation, opportunity, and/or ability to cooperate but that nevertheless have been selected for management (e.g. keeping preteen girls from beginning to smoke). The tools are considered with respect to targets who are prone, resistant, or unable to comply with the manager's goals. The relative appropriateness of the use of various Michael L. Rothschild