1991: 3% of the $750 billion spent on health care was for prevention

1. Avert occurrence of a diseas or injury (immunizations, tax cigarettes)

2. Early detection and intervention (Pap smears, mammograms)

3. Minimize the effects of disease and dissability (physical therapy)

1. Improve standard of living

2. Public Health interventions to reduce illness (education, ban smoking)

3. Health care providers performing preventetive actions

The First Epidemiologic Revolution

Reducing poverty, overcrowding, oor nutrition, and contaminated food supplies and implementing water purification, sewage disposal, and pasturization of milk

medical treatments account for less than 5% of the decrease in mortality rates siince the 19c.--most of it is public health measures

The Second Epidemiologic Revolution

Current declines in premature death or dissability are due more to education (stop smoking, less fat, less alcohol, cholestorol) than medical treatments

Individual of Population?

Medical model looks at the individual rather than the whole popluation as public health does

Medical model may target the wrong individuals: (a 10% nation-wide reduction in cholesterol levels is better than a 30% reduction for some high end cases becaus the norm is so high)

Medical: emphesis on the individual creating the problems

Public Health: emphesis on the society creating the problems

Need preventetive care as well

Models of Prevention

primary prevention (risk factors well known) gives 32% decrease from 1968-1981

physicians can easily and cheaply (in the long run) influence people to stop smoking

NIH concentrated on screening:

problem: life long medication to reduce cholesterol adds 7 months to 35 year old men and 6 weeks for 55 year olds

reduction in blood pressure is much more sucessfull at controling CHD than choesterol

don’t really know what causes it: identified risk factors only account for 1/4 of the cases

Secondary intervention (screening) can reduce mortality by 1/3

guns and alcohol

large amounts of violence on tv

racial oppression

large income variances

impossible to treat

specific methods of infection

hard to change habits quickly

CHD-primary prevention sucessful

Breast Cancer-secondary somewhat sucessful

Violence-causes not konwn

AIDS-causes known, but primary prevention not very sucessful

Does Prevention Reduce Medical Care Cost?

almost always cheaper

prenatal care, smoking counselling, vaccines save lots of money

cholesterol-lowering meidcations only recoup 22% of their cost

Conclusion

So far prevention and public health programs have had a greater effect (since 19c.) on health outcomes than any medical treatment--they are still enormously more cost effective and should be expanded