Health promotion programs have been hailed as having great potential to help solve the problem of rapidly increasing health care costs. In order to assess whether health promotion programs are "worth it," some kind of cost-benefit or cost-effectiveness analysis must be included as part of program evaluation. This article provides a basic introduction to the concepts of cost-benefit and cost-effectiveness analysis, compares them, and presents a simple procedure for performing a basic cost-effectiveness analysis. The potential for health promotion programs to impact on the rising costs of medical care is discussed.
Chemical mutagens are recognized as prevalent in the environment and a potential threat to the health of future generations. This paper presents an overview of chemical mutagenesis as an issue for public health. Several problems in the determination of risk to human populations are discussed, includingIn the last decade we have become painfully aware that our burgeoning technology has produced some highly undesirable side effects. The increasing prevalence of toxic substances in the environment has become a matter of public interest as a complex public health problem. To date the federal government has been concerned primarily with toxicity and carcinogenicity as targets for regulation, but the recently passed Toxic Substances Control Act authorizes the regulation of mutagenic agents.' Regulatory decisions for the control of mutagenic substances are extraordinarily complex due to the difficulty of extrapolating the scientific data to humans, the long period of latency between exposure and adverse recognizable damage, the lack of public awareness of mutagenesis as a threat to health, and the huge number of chemicals in use whose mutagenic status is unknown. It is the purpose of this paper to summarize some information on mutagenesis in the context of public health, with the hope of stimulating discussion of this complex issue among public health professionals.Mutagenic agents cause changes in the existing genetic material. Because mutations in reproductive cells may be carried in the recessive state through several generations, effects of mutagenic agents are likely to be hidden for decades. Specific agents may never be associated with specific
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