An Ounce of Prevention is Worth a Pound of Cure

At some point in our lives we all visit the doctor with a complaint.  The physician will diagnose and treat you based on medical history, physical examinations, and diagnostic testing – the focus will be entirely on your “broken” part, usually to the exclusion of almost everything else.  This disease-centric “medical model” of health care is decidedly un-holistic; environmental factors, social issues, diet, stress, sleep, and other influences are rarely considered or evaluated when making diagnostic and treatment decisions.  Similarly, the doctor can only fix what is broken; thus, the emphasis is on disease treatment not prevention.

Many would argue the medical model has been working just fine – and they would be correct.  Over the last 60 years the U.S. has enjoyed a drastic increase in life expectancy and a decline in mortality rate from many diseases.   For example, between 2000 and 2011, statistics show that cardiovascular deaths decreased by 3.79% annually.   These impressive reductions are largely attributed to modern medical advancements and pharmaceutical use (statins, aspirin, and beta blockers).  

However, beginning in 2011, the nationwide rate of decline slowed to just 0.65% annually.  In Florida, the rate has been slowly increasing since 2009. Could it be that the medical model can only take us so far along our road to better health?  Are there alternate routes we should explore? 

Unlike the medical model, public health efforts focus heavily on prevention.  Public health initiatives have been enormously successful at reducing the rates of infectious disease.  Sewage disposal, water treatment and chlorination, food safety, organized solid waste disposal, tuberculosis control programs, mosquito control practices, quarantines, public education about hygienic practices (e.g., food handling and hand washing), and vaccinations all played a part. Although often uncredited, public health initiatives have been vital in reducing mortality rates from chronic diseases, including cardiovascular diseases.  Community outreach and education programs, and direct screening efforts have focused public attention on the risks associated with high blood pressure, high cholesterol, and smoking - all key contributing factors in the development of cardiovascular disease. In fact, a study completed by the Harvard School of Public Health found that 25% of the reduction in cardiovascular disease mortality between 1980 and 1990 is attributable to public health interventions.

It has been hypothesized that the recent decline in the improvement rate in cardiovascular deaths is attributable to the rise in the obesity rates.   If true, we can only expect to see a continual increase in cardiovascular deaths as the “fix” involves dietary modification, exercise, and behavior changes – all solutions largely outside the purview of medical practice.