An evaluation of the health hazard appraisal based on survey data from a randomly selected population

The Special Projects Division of the City of Milwaukee Health Department conducted a telephone survey among randomly selected adult residents to determine the population having the greatest potential for benefiting from a health screening a counseling program. A modified version of the Health Hazard Appraisal (HHA) was completed by 268 respondents. From the survey results, it was estimated that by reducing various health risk factors, the respondents could lower their current probability of dying within 10 years by an average of 22 percent. The major predictor of the percentage of reducible risk was age. Persons 18-39 years old could reduce their current probability of dying within 10 years by an average of about 10 percent, whereas persons 40 years and older could reduce theirs by an average of more than 30 percent. Men could lower their probability by slightly more than women, but other sociodemographic factors, such as race, income, education, and residential area, either did not predict significantly the percentage of reducible risk or did so only because of their correlation with age. The results raise questions about the HHA's accuracy in calculating reducible risk, its use of death postponement information to motivate changes in behavior, and its value in health promotion programs, particularly for young adults who are not likely to die of chronic diseases within 10 years. The HHA should only be considered for public health screening programs that target middle-aged and, perhaps, elderly populations rather than the general population of persons under 40 years old.