Can general practitioners influence the nation's health through a population approach to provision of lifestyle advice?

Background, Lifestyle advice from general practitioners (GPs) has been show n to have a positive effect on population health. In practice, GPs provide lifestyle advice to a minority of their patients only, those who are high r isk or already have symptoms. Aim. To look in depth at GPs' attitudes towards adopting a population appro ach to lifestyle advice and to use these results to identify ways of maximi sing the potential of GPs to affect population health. Method. Thirty-six GPs, purposively sampled by identifying characteristics likely to affect their health promotion activity, participated in a focus g roup study. Data from the focus groups were transcribed verbatim and analys ed using standard methods. Results. The main themes that emerged suggested that GPs do not take a popu lation approach to lifestyle advice because they prefer a high risk approac h and doubt their ability to be effective in a population approach. GPs bel ieved that social, cultural, and environmental factors were the most import ant determinants of population health. Furthermore, they were concerned abo ut the detrimental effects on the doctor-patient relationship of providing lifestyle advice to all patients. GPs believed that a multiagency, centrall y co-ordinated approach was the preferred way to improve population health and that their role should be limited to secondary prevention. Conclusion. Large amounts of resources would be necessary to convince GPs t o adopt a population approach to lifestyle advice. Measures to tackle the s ocial and environmental determinants of health may be a more effective and efficient means of improving the nation's health.