BACKGROUND AND HISTORY OF THE HEALTH RISK APPRAISAL
Over half of all deaths before age 65 can now be attributed to lifestyle factors (Amler & Dull,
1987; Foege & McGinnis, 1995). In order to reduce the annual incidence of these causes of death, it is essential to understand
the contribution of such factors as smoking, smokeless tobacco, alcohol consumption, substance abuse, nutrition, exercise,
stress, driving habits, seat belt usage, ATV use, and use of preventive services such as mammograms. The tools that can help
to assess the impact of these precursors of disease and trauma include the methodology of health risk appraisal. Many of the
decisions made in the course of development of a health risk appraisal instrument are inherently transient and subject to
constant improvement and customization. Factors such as the age, sex, or culture of the target population, the selection of
causes of illness, injury, or death, the identification of the precursors of these outcomes, and the quality of the synthesis
of the underlying science all contribute to the definition of any given health risk appraisal.
On the basis of the Centers for Disease Control Risk Factor Update Project (Breslow, L., et al., 1985) and
involvement with a broad range of other governmental units, volunteer health agencies, research centers, and scientific and
technical advisory committees, in 1986 and 1987 the Centers for Disease Control and Prevention (CDC) collaborated with the
Carter Center of Emory University in Atlanta in a major review and updating of the scientific basis for the HRA (Amler, Moriarity,
and Hutchins, 1988). At the end of this project, operation of the national public domain HRA program was transferred from
the CDC to the Carter Center of Emory University, which continued the development and dissemination of the HRA until the end
of 1991. In anticipation of the completion of the Carter Center’s five-year commitment to the national HRA program,
The HEALTHIER PEOPLE NETWORK (HPN) was established as a freestanding 501-c-3 non-profit corporation to ensure the long-term
viability of a public interest health risk appraisal program.The HEALTHIER PEOPLE NETWORK (HPN) continues
the programmatic effort, which originated at the CDC to develop and make widely available scientifically valid health risk
appraisal computer programs. HPN also continues the CDC tradition of periodic updating of the science underlying health risk
appraisal, enhancing the technology to facilitate its use, and broadly disseminating it so that the public interest can be
served.
Continuing work on The HEALTHIER PEOPLE NETWORK Health Risk Appraisal involves regular scientific
updating of the national mortality tables (a basic building block of the health risk appraisal), expanding current mortality
based models to include morbidity and functional status assessments, extending the age range to include both older and younger
populations, and the incorporation of occupational and environmental risk factors. Technical developments focus on making
the software user friendly and allowing the addition of questionnaire items of specific interest to the local user.
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