John Frank and Erica Di Ruggiero's paper, "Prevention: Delivering the Goods," with its focus on prevention, is very timely as current developments in infectious diseases, in particular SARS, bring the field of public health to the forefront. Excellence in public health practices is easily overlooked or taken for granted - yet, safe water, air, food and other environmental factors are essential to our survival.
Frank and Di Ruggiero ask why prevention has been so slow to have a major effect. The authors are eminently qualified to answer such a question because of their wealth of experience and education in disease prevention and health promotion. As they point out, it is not exactly clear what is meant by "good" preventive practice. We all know from personal experiences how confusing expert opinion can be. For example, if we want to reduce our probability or risk of heart failure we are advised to do a combination of the following: eat healthily (which can be interpreted in many ways - lower fat intake, no red meat, eat lots of fruit and vegetables), lose weight, exercise regularly (varying advice about how much and what type), take aspirin daily and/or a wide variety of other dietary supplements. Add these probabilities together and follow the advice, we should all live to over 100, but we all know that is unlikely. Frank and Di Ruggiero attribute the lack of progress in prevention to our "premature enthusiasm" for new approaches and the constant search for a magic bullet.
In terms of healthy behaviours, we may all have good intentions, but unfortunately we let things slide. The authors remind us how challenging it is to carry out simple preventive practices such as forgetting to floss or brush our teeth.. Even more difficult is trying to change a behaviour such as smoking, even though the evidence against it is clear. Prevention may be better than cure, but we are all vulnerable to effects of genetics and social circumstances.
Frank and Di Ruggiero stress the importance of opening up a public dialogue if we want large-scale prevention to work. They make a case for multiple interventions, at both the individual and community levels, to make the culture more receptive to change. We all have a great deal to learn about how to make the case for prevention stick.
About the Author(s)
Peggy Leatt, PhD
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