The Need for more and better public health services

I notice that The End of Illness byDavid B. Agus is getting a lot of attention. Agus' basic point is that appropriate preventive measures can be very effective at preventing illness. They can also be much more cost effective than our available curative services.

The great progress in the 20th century in improving health in developed countries was in the improvement of hygiene and sanitation, improvement of nutrition, and public health measures to prevent the transmission of communicable disease. Antibiotics helped!

Agus is an oncologist, and his clinical experience is with one of the diseases of aging, a disease which is increasingly seen as chronic, requiring long term treatment. He is of course much better qualified than I am to describe the research that has shown that simple means -- an aspirin a day, exercise, a proper diet, not smoking -- can reduce the incidence, or at least delay the onset of many diseases common in our aging population.

I would note that when I started working in the area of public health in developing countries in 1970, the emphasis was on interventions to increase child survival, including immunizations, nutrition education, hygiene, and education of mothers to assure that they sought simple medical care for sick kids in a timely fashion. The world has changed, and poor countries too are seeing a lot more older people and a lot more cancer, heart disease, and dementia.

In the old days, as well as today, people seem willing to spend a lot more for curative services when they are sick than for preventive services when they are not sick. Perhaps it is time to think with our rational mind about health service priorities rather than with our primitive brain. We should focus more on preventive services!