Healthy, Wealthy, or Wise? Issues in American Health Care Policy

By Charles T. Stewart Jr. | Go to book overview

11
Prevention: Environmental and Behavioral Modification

Before the Industrial Revolution, the average life expectancy was in the twenties; the preindustrial environment was deadly. Industrial civilization, although it has created new risks, has attained life expectancy in the upper seventies. Health and life have been improved in three ways: by altering the environment to reduce its threats; by protecting individuals and populations from environmental threats; and by learning to treat illness and injury.

In some instances, there are tradeoffs: prevention versus protection versus treatment. In other cases, we have no choice: we lack treatment for most viruses, but we can vaccinate or quarantine; we cannot protect individuals from polluted outdoor air, but we can reduce pollution. How do we allocate resources between public health prevention (environment), individual prevention (behavior), and treatment? Is prevention just an added cost of health care, or is it a means of reducing medical care needs and spending?

If we measure the conquest of disease in terms of mortality and life expectancy, the first great step forward was the dramatic fall in infant and child mortality in the late nineteenth and early twentieth centuries, almost entirely the result of improvements in prevention via public health measures: safe drinking water, sewage disposal, reduction in disease vectors. The second great advance, in the first half of the twentieth century, was a combination of prevention and treatment: new vaccines, further improvements in public health, food inspection, culminating in the antibiotic revolution of the 1940s. The third advance, in which we find ourselves, is defensive as well as preventive: staving off, slowing down the killers of middle and old age, prolonging the lives of the elderly instead of saving the lives of the young. It involves new medical technology, modification of lifestyles, and new measures for environmental modification, in particular the elimination or reduction of harmful chemicals rather than microorganisms.

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Healthy, Wealthy, or Wise? Issues in American Health Care Policy
Table of contents

Table of contents

  • Title Page iii
  • Contents v
  • Preface vii
  • Notes viii
  • 1 - Determinants of Health 1
  • Notes 6
  • 2 - Why Are Costs Out of Control? 7
  • Notes 27
  • 3 - Must Living Standards Decline? 28
  • Notes 38
  • 4 - Health Insurance Raises Demand and Supply 40
  • Notes 49
  • 5 - The Excess of Physicians and Services 51
  • Notes 77
  • 6 - The Medicalization of Health 82
  • Notes 97
  • 7 - Mental Illness 99
  • Notes 119
  • 8 - The Excessive Demand for Medical Care 123
  • Notes 136
  • 9 - Research and Technology 138
  • Notes 161
  • 10 - The Physician as Agent 164
  • Notes 179
  • 11 - Prevention: Environmental and Behavioral Modification 181
  • Notes 210
  • 12 - The Demedicalization of Health Care 213
  • Notes 222
  • 13 - What to Do? 223
  • Notes 250
  • Index 253
  • About the Author 263
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