Last (1983) defines public health as:

Recommended goals and targets for addressing national public health problems and directed at reducing the amount of death and premature death have been proposed in many countries over the past 10 years, including the United States of America (United States Department of Health and Human Services, 1990), the United Kingdom (Department of Health, 1992), Canada (Ontario Premiers' Council on Health, 1987) and Australia (Nutbeam, Wise, Bauman, Harris, & Leeder, 1993). In Australia for example, over the past 2 years, much attention has been directed at health outcomes related to cardiovascular disease, cancers, accidents and injuries and mental health. All of these reports have emphasised the importance of changing those lifestyle and related risk factors associated with preventable causes of death. Priority lifestyle areas that have been identified include physical inactivity, diet and nutrition, smoking, alcohol and other drug use, safety behaviours, sun protective behaviours, appropriate use of medicines, immunisation, sexuality and reproductive health, oral hygiene, and mental health. Priority populations and appropriate settings for intervening in these areas have also been identified.

Physical inactivity is a risk factor for a number of chronic diseases, including cardiovascular disease. Interventions designed to reduce the prevalence of physical inactivity have focused primarily on either adoption of physical activity or noncompliance and relapse, and no interventions have been reported which cover adoption, compliance, maintenance, and relapse, particularly within the clinical setting. The Fresh Start program, a multiple risk factor intervention program for the reduction of cardiovascular disease risk factors in general practice patients, was developed to cover all aspects of the adoption and maintenance of habitual physical activity, using Prochaska and DiClemente's Transtheoretical model. The evaluation of the program on cardiovascular disease risk factors and behaviours provided the opportunity to evaluate the impact of a staged program on patient physical activity behaviour. The program was evaluated in a randomised controlled trial in Sydney's Western, South-western, and Wentworth regions with 80 volunteer general practitioners and 758 volunteer patients between January 1991 and January 1993. Self-reported physical activity data were used as the basis for estimating energy expenditure due to leisure-time physical activity. The results failed to show any differences between groups over time, as a function of patients' baseline stages of change, and as a function of baseline activity levels. There were some indications, however, that the least active would respond to doctor-based advice to increase their physical activity, and that doctor advice would lead to a progression in intention to change in approximately 20% of patients. Limitations of the study, the program, and physical activity intervention in the clinical setting are discussed.

A primary health care community intervention program was offered to the middle-aged female population in a Swedish community aiming at reducing risk factors for cardiovascular disease. Around 30% of women with risk factors took active part in an intervention course program inspiring to lifestyle changes. Analysis showed few background differences between the group of women who participated and who did not participate in the intervention program. Most women with risk factors benefited from lifestyle changes, those with multiple risk factors to as large an extent as those with few risk factors for cardiovascular disease. Also women with risk factors who did not take part in the intervention course program changed their lifestyle habits to some extent.The pedagogics of the intervention program described in this paper are shown to be of value when addressed to middle-aged women with risk factors for cardiovascular disease.

National policy directions currently provide an environment in which mental health promotion activities can be widely supported in health and related arenas. Several recent national reports have identified the importance of primary care, especially in general practice settings, as the principal point of entry to the Australian health care system. A broad overview of the current policy climate prefaces a discussion of the opportunities for mental health promotion in the primary care sector, focusing on general practice settings and using depression as an example. Implications and consequences related to training of the mental health workforce, with special reference to roles for psychologists are discussed. Finally, recommendations are made for future directions in mental health promotion and prevention research in primary care.

General practitioners have been suggested as occupying a position in the community that offers considerable potential for reducing the prevalence of health risk behaviours. Green, Eriksen, and Schor (1988) have proposed that if general practitioners are to effectively adopt a role in modifying patient health risk behaviours, a number of prerequisite conditions must be met. Using the model proposed by Green et al., this paper reviews the literature to describe the circumstances under which general practitioners currently practise this role. The review focuses on the circumstances relating to practitioner modification of one patient health risk behaviour: smoking. Research detailing the extent of practitioner involvement in the modification of this risk behaviour is also reviewed. The paper concludes by discussing the opportunities available for behavioural scientists to facilitate general practitioners' adoption of a role in patient smoking cessation.

Antihypertensive drug therapy may reverse the cardiac and vascular structural changes associated with sustained hypertension. This may enable appropriate blood pressure levels to be maintained with milder forms of therapy (such as lifestyle interventions) which will minimise any potential adverse effects of pharmacological therapy. The HEART project was conducted in the general practice setting and aimed to determine whether lifestyle strategies, such as increased physical activity and dietary modification, could be substituted for drug therapy in patients who had been well controlled on antihypertensive medication. In addition to objective measures of blood pressure and risk factor outcomes, attitudes and perceptions of general practitioners (GPs) and patients involved in the trial were assessed through focus group discussion and personal interviews. Of the 44 patients recruited to the trial, 41 (93%) participated in structured interviews of 20–40 minutes duration conducted in person or by telephone. Of 78 GPs working in the western suburbs of Melbourne who were approached about the trial, 50% were willing to participate. Of these, 13 (34%) recruited study patients. Of these 13, 10 (77%) participated in a 2-hour focus group discussion which was audiotaped for later transcription and analysis. Despite being enthusiastic about lifestyle interventions in principle, nearly all of these GPs felt resistant to the concept of withdrawing medication in well-controlled subjects. They were generally surprised to see that many patients (15 of 20 patients: 75%) were able to maintain appropriate blood pressure levels following drug therapy withdrawal and adoption of minimal lifestyle changes. GPs felt that the patients' eagerness to come off medication was the major incentive for patients to participate in the trial. This was corroborated by many patients indicating a desire not to be taking any medication. The majority of patients reported making minor changes in lifestyle behaviours leading to most being able to remain off therapy or to have drug dosage requirements reduced. The major barriers to maintaining lifestyle change were family and work stresses and the perception of the intervention not being treated as a therapy thus not at the same level of importance as a treatment method as drug therapy. It appears that a select group of hypertensive patients, highly motivated by the prospect of drug therapy withdrawal, were interested in and willing to trial a lifestyle behaviour change approach for their blood pressure management. The majority reported that they had been able to adopt small but meaningful changes in exercise and dietary habits through the provision of stand-alone self-help materials and support from their GP. Of these patients, 75% remained normotensive without drug therapy after a 9-month follow-up period.