AFrameworkforPublicHealthAction:TheHealthImpactPyramid

A 5-tier pyramid best de- scribes the impact of different types of public health inter- ventions and provides a framework to improve health. At the base of this pyramid, indicating interventions with the greatest potential impact, are efforts to address socio- economic determinants of health. In ascending order are interventions that change the context to make individ- uals' default decisions healthy, clinical interventions that re- quire limited contact but con- fer long-term protection, ongoing direct clinical care, and health education and counseling. Interventions focusing on lower levels of the pyramid tend to be more effective because they reach broader segments of society and re- quire less individual effort. Implementing interventions at each of the levels can achieve the maximum pos- sible sustained public health benefit. (Am J Public Health. 2010;100:590-595. doi:10.