Even more contentious was the issue of the prevention and management of non-communicable diseases, through one-on-one counselling about lifestyle risk factors (e.g. smoking, poor nutrition, risky alcohol use and lack of physical activity), and the early detection and management of biological risk factors such as high blood pressure and high cholesterol in the prevention of heart disease and stroke. Many public health practitioners regarded these activities as clinical practice. Some suggested that a distinction can be made on the basis of whether people have symptoms or signs of disease. For example, helping people to quit smoking would be considered a public health activity when they are symptom free, but part of clinical medicine if they have any symptoms or signs of disease or a history of previously diagnosed disease. Apart from any conceptual objections to such a distinction, it would be difficult to operationalise in practice.