The ups and downs of prevention.

Abstract

EDITORIALStionally satisfying. There are many examples of a relationship between health and an individual's assumption of responsibility for the consequences of personal practices, e.g. consuming food, liquor, drugs, wearing protective devices on the job, buckling auto safety belts, complying with prophylactic or therapeutic regimens, etc. Theoretical arguments against acceptance and ultimate dissemination of the Heart Healthy curriculum include: the need to extend the limited observations of Coates, et al, in order to establish the replicability and generalizability of their initial observations, the possible low cost-benefit of this curriculum component compared to some other curriculum, and the possibility that childhood diet and exercise may not affect adult cardiovascular disease appreciably.The preceding reflections should in no way detract from the contribution represented by the study of Coates and his colleagues. These investigators undertook a difficult evaluation with limited state-of-the-art tools and demonstrated that health education effectiveness could be measured objectively and that children's behaviors could be changed by relatively efficient means. Whether or not the specific behaviors they changed are critical to health seems less important than the fact that behaviors can be changed by soundly based and executed health education, when and if the relationship of these behaviors to health are established.

The value of medical care for health promotion.

“…But most important is the practical convenience for people, the administrative efficiency, and the greater community impact of providing preventive and treatment services at the same local facilities, often at the same time. 49 The customary separation of prevention and medical care in the free-market countries has been due to political, not managerial, considerations.…”

Review Article : Implementing Preventive Care in Clinical Practice

“…This question has received some discussion in the health services literature, resulting in a better definition of the issues involved without arriving at a clear and compelling resolution (Hamburg 1979, Saward and Sorenson 1978, Winkelstein 1977, Yankauer 1981. To some extent, of course, a decision regarding the appropriate locus of responsibility and site of activity depends upon the characteristics of the target population and the nature of the additional services to be rendered (compare Fletcher et al 1977).…”

“…At least since the 1920s, medical professionals in this country have advocated regular &dquo;checkups&dquo;, initially described as annual physical exams to avoid the &dquo;threat of middle age&dquo; (Rosen 1977). Growing professional discomfort with the utility of such exams (Yankauer 1981), increasing recognition of the multifactorial etiology and &dquo;incurability&dquo; of most chronic diseases diagnosed at the &dquo;usual&dquo; point in their natural history, and the emergence of laboratory tests (many highly automated) which could be used to screen for disease have all provided the stimulus to the medical profession to reexamine and redefine the content of regular examinations (e.g., Taylor 1980, Douglass 1981). Other stimuli to professional interest in preventive care may have been provided by increasing concern with promoting good health (jogging, anyone?)…”