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Clinical perspectives
PREVENTIVE
MEDICINE
16,
13 1- 133
(1987)
EDITORIAL Clinical
Perspectives
There is increasing evidence that health and longevity can be considerably influenced by personal lifestyle decisions. Among the most significant of the medical developments of the 1970s was the growth in our awareness and understanding of how important health promotion and disease prevention could be in the control of avoidable morbidity and mortality. In 1979, the U.S. Public Health Service published the landmark report, “Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention” (3). A major finding documented in this report was that the most impressive health gains of the 20th century thus far were due, in large part, to the development and implementation during the early part of the century of a variety of preventive measures. These measures were designed primarily to control the spread of the infectious diseases -the primary causes of death at the time. They included improvements in sanitation, housing, and immunization. The principal health problems confronting Americans today, however, are chronic degenerative diseases and traumatic injury, health problems that can be effectively controlled through changes in behavioral patterns and lifestyle. A basic premise, therefore, of “Healthy People” was that the most significant improvements in future health status would most likely result from efforts to promote healthful lifestyles. This recognition marked a major shift in emphasis from disease treatment toward disease prevention. Specifically, the report identified 15 priority areas in which health promotion and disease prevention efforts might be expected to achieve improvements in health. These priority areas included: smoking and health improved nutrition l physical fitness and exercise l accident prevention and injury control l high blood pressure control l prevention of drug and alcohol misuse 0 family planning l pregnancy and infant health 0 immunization l sexually transmitted disease control l toxic agent and radiation control l occupational safety and health l fluoridation and dental health l surveillance and control of infectious diseases l control of stress and violent behavior l l
These 15 priority
areas were subsequently
translated into 227 measurable
objec-
131 0091-7435187
$3.00
Copyright 0 1987 by Academic Press, Inc. All rights of reproductmn in any form reserved.
132
WYNDER
AND
ORLANDI
tives to be attained by the year 1990 (4). Various public and private health agencies, state and local departments of health, professional health associations, and voluntary health organizations have begun to collaborate in an effort to achieve these objectives. The task, however, is monumental and a number of critical gaps remain. These gaps were recently outlined by the U.S. Department of Health and Human Services in a report that evaluated our progress thus far in achieving the 1990 objectives (5). This report identified health-care settings as one of the primary areas in which improvement is critically needed. Despite the obvious analogies between the goals of traditional health care and the 1990 objectives, settings such as hospitals, community health centers, and private physicians’ offices have not even begun to reach their potential with respect to health promotion and disease prevention (1, 2). The problem is not simply one of insufficient preventive technologies. A vast array of preventive interventions has been developed and evaluated through a variety of health promotion research efforts and these interventions are potentially available for application. On the contrary, the root of this problem, which has not been adequately addressed in the scientific literature, relates to the transfer of existing preventive technologies and to the barriers to effective diffusion and adoption of such innovations in health-care settings. In recognition of the gap that currently exists between the potential for disease prevention in health-care settings and the application of currently available preventive technologies, Preventive Medicine will initiate a regular section, to appear periodically. This section, called “Clinical Perspectives,” will focus on both the opportunities and the barriers to promoting health in health-care settings. It will feature both solicited and unsolicited articles from nationally recognized experts in areas such as smoking cessation, blood lipid screening, cervical cancer screening, and other prevention technologies. Issues such as medical decision analysis, third-party reimbursement, and cost-effectiveness as they relate to health promotion and disease prevention will also be discussed. The primary orientation of this section will not be toward the reporting of new data, but rather to provide practioners and others with state-of-the-art information and practical advice regarding what is effective in the practice of preventive medicine in healthcare settings. As such, this section should serve as an aid to both decision-makers and practioners in health-care settings who must answer pragmatic questions related to health-care planning and the selection of services to be provided. This section will also serve as a sounding board for the developers and evaluators of preventive technologies, helping them to understand what happens as various innovative approaches are translated from the drawing board to the evaluation setting, and subsequently transferred to real-world applications. Above all, it is our hope that this new section will stimulate dialogue and provide a forum for the exchange of new ideas and useful information leading to an ever-increasing use of existing technologies for disease prevention in the doctor’s office, in hospitals, and in health-care settings in general. If the 1990 objectives for the nation are to be achieved, this type of communication is critical. Comments, criticism, or suggestions from our readers are welcomed.
EDITORIAL
133 ERNST L. WYNDER,
M.D.
Editor-in-Chief MARIO
Consultant,
A.
ORLANDI,
PH.D.,
Health Promotion
M.P.H.
Research
REFERENCES 1. Blum, A. Medical activism, in “Health Promotion Principles and Clinical Applications” (R. B. Taylor, J. R. Ureda, and J. W. Denham, Eds.), pp. 373-391. Appleton-Century-Crofts, Norwalk, CT, 1982. 2. Nutting, P. A. Health promotion in primary medical care: Problems and potential. Prev. Med. 15, 537-540 (1986). 3. U.S. Department of Health, Education, and Welfare. “Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention.” U.S. Govt. Printing Office, Washington, DC, 1979. 4. U.S. Department of Health and Human Services. “Promoting Health/Preventing Disease: Objectives for the Nation.” U.S. Govt. Printing Office, Washington, DC, 1980. 5. U.S. Department of Health and Human Services. “Proceedings of Prospects for a Healthier America: Achieving the Nation’s Health Promotion Objectives.” U.S. Govt. Printing Office, Washington, DC, 1984.
MEDICINE
16,
13 1- 133
(1987)
EDITORIAL Clinical
Perspectives
There is increasing evidence that health and longevity can be considerably influenced by personal lifestyle decisions. Among the most significant of the medical developments of the 1970s was the growth in our awareness and understanding of how important health promotion and disease prevention could be in the control of avoidable morbidity and mortality. In 1979, the U.S. Public Health Service published the landmark report, “Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention” (3). A major finding documented in this report was that the most impressive health gains of the 20th century thus far were due, in large part, to the development and implementation during the early part of the century of a variety of preventive measures. These measures were designed primarily to control the spread of the infectious diseases -the primary causes of death at the time. They included improvements in sanitation, housing, and immunization. The principal health problems confronting Americans today, however, are chronic degenerative diseases and traumatic injury, health problems that can be effectively controlled through changes in behavioral patterns and lifestyle. A basic premise, therefore, of “Healthy People” was that the most significant improvements in future health status would most likely result from efforts to promote healthful lifestyles. This recognition marked a major shift in emphasis from disease treatment toward disease prevention. Specifically, the report identified 15 priority areas in which health promotion and disease prevention efforts might be expected to achieve improvements in health. These priority areas included: smoking and health improved nutrition l physical fitness and exercise l accident prevention and injury control l high blood pressure control l prevention of drug and alcohol misuse 0 family planning l pregnancy and infant health 0 immunization l sexually transmitted disease control l toxic agent and radiation control l occupational safety and health l fluoridation and dental health l surveillance and control of infectious diseases l control of stress and violent behavior l l
These 15 priority
areas were subsequently
translated into 227 measurable
objec-
131 0091-7435187
$3.00
Copyright 0 1987 by Academic Press, Inc. All rights of reproductmn in any form reserved.
132
WYNDER
AND
ORLANDI
tives to be attained by the year 1990 (4). Various public and private health agencies, state and local departments of health, professional health associations, and voluntary health organizations have begun to collaborate in an effort to achieve these objectives. The task, however, is monumental and a number of critical gaps remain. These gaps were recently outlined by the U.S. Department of Health and Human Services in a report that evaluated our progress thus far in achieving the 1990 objectives (5). This report identified health-care settings as one of the primary areas in which improvement is critically needed. Despite the obvious analogies between the goals of traditional health care and the 1990 objectives, settings such as hospitals, community health centers, and private physicians’ offices have not even begun to reach their potential with respect to health promotion and disease prevention (1, 2). The problem is not simply one of insufficient preventive technologies. A vast array of preventive interventions has been developed and evaluated through a variety of health promotion research efforts and these interventions are potentially available for application. On the contrary, the root of this problem, which has not been adequately addressed in the scientific literature, relates to the transfer of existing preventive technologies and to the barriers to effective diffusion and adoption of such innovations in health-care settings. In recognition of the gap that currently exists between the potential for disease prevention in health-care settings and the application of currently available preventive technologies, Preventive Medicine will initiate a regular section, to appear periodically. This section, called “Clinical Perspectives,” will focus on both the opportunities and the barriers to promoting health in health-care settings. It will feature both solicited and unsolicited articles from nationally recognized experts in areas such as smoking cessation, blood lipid screening, cervical cancer screening, and other prevention technologies. Issues such as medical decision analysis, third-party reimbursement, and cost-effectiveness as they relate to health promotion and disease prevention will also be discussed. The primary orientation of this section will not be toward the reporting of new data, but rather to provide practioners and others with state-of-the-art information and practical advice regarding what is effective in the practice of preventive medicine in healthcare settings. As such, this section should serve as an aid to both decision-makers and practioners in health-care settings who must answer pragmatic questions related to health-care planning and the selection of services to be provided. This section will also serve as a sounding board for the developers and evaluators of preventive technologies, helping them to understand what happens as various innovative approaches are translated from the drawing board to the evaluation setting, and subsequently transferred to real-world applications. Above all, it is our hope that this new section will stimulate dialogue and provide a forum for the exchange of new ideas and useful information leading to an ever-increasing use of existing technologies for disease prevention in the doctor’s office, in hospitals, and in health-care settings in general. If the 1990 objectives for the nation are to be achieved, this type of communication is critical. Comments, criticism, or suggestions from our readers are welcomed.
EDITORIAL
133 ERNST L. WYNDER,
M.D.
Editor-in-Chief MARIO
Consultant,
A.
ORLANDI,
PH.D.,
Health Promotion
M.P.H.
Research
REFERENCES 1. Blum, A. Medical activism, in “Health Promotion Principles and Clinical Applications” (R. B. Taylor, J. R. Ureda, and J. W. Denham, Eds.), pp. 373-391. Appleton-Century-Crofts, Norwalk, CT, 1982. 2. Nutting, P. A. Health promotion in primary medical care: Problems and potential. Prev. Med. 15, 537-540 (1986). 3. U.S. Department of Health, Education, and Welfare. “Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention.” U.S. Govt. Printing Office, Washington, DC, 1979. 4. U.S. Department of Health and Human Services. “Promoting Health/Preventing Disease: Objectives for the Nation.” U.S. Govt. Printing Office, Washington, DC, 1980. 5. U.S. Department of Health and Human Services. “Proceedings of Prospects for a Healthier America: Achieving the Nation’s Health Promotion Objectives.” U.S. Govt. Printing Office, Washington, DC, 1984.