preventive medicine. Until the early 20th century
even doctors did not often wash their hands, not
even between seeing patients. This was largely a
function of ignorance. Until Lister, Koch, Pasteur,
and others demonstrated the existence of bacteria
and their causal relationship to infection, doctors
and others simply did not know their hands car-
ried the agents of disease. Health experts today
believe that frequent hand washing could prevent
90 percent or more of the infections that occur.
THE US CENTERS FOR DISEASE CONTROL AND
PREVENTION’S (CDC’S) 10 MOST SIGNIFICANT PUBLIC
HEALTH ACHIEVEMENTS OF THE 20TH CENTURYcontrol of infectious diseases
decline in deaths from heart disease and STROKE
FAMILY PLANNING
FLUORIDATIONof drinking water
healthier mothers and babies
motor-vehicle safety
recognition of TOBACCOuse as a health hazard
safer and healthier foods
safer workplaces
vaccination
Source: CDC, MMRW Weekly, April 2,1999, 48(12):241–243.
Health discoveries in the 1950s and 1960s began
to connect lifestyle habits with health and disease.
The landmark surgeon general’s report of 1964
established the scientific correlation between ciga-
rette smoking and LUNGdisease, notably lung CAN-
CER. Research explored the roles of nutrition and
exercise in preventing disease and even in the early
1960s issued recommendations for daily “calisthen-
ics” to maintain the physical health of the body.
Fast food (available in restaurants and from grocery
stores) changed EATING HABITSand body weight, and
health experts noted alarming rises in CARDIOVASCU-
LAR DISEASE(CVD) and type 2 DIABETES.
In 1900 heart disease was the fourth leading
cause of death in the United States; by 1977 it had
become, and today remains, number one. Though
infections such asHIV/AIDSand HEPATITISremain sig-
nificant threats to personal and public health, the
greatest challenges are now those that are nearly
exclusively within the realm of individual control.
Health promotion emphasizes community-based as
well as individual preventive efforts that target
modifiable risk factors for injury, illness, and dis-
ease. Recommendations for individual preventive
health measures emphasize nutritious eating habits
and daily exercise, urge SMOKING CESSATION, pro-
mote IMMUNIZATION, and encourage routine health
screenings for early detection and treatment of dis-
ease. Health experts believe lifestyle modifica-
tions—reduction of personal health risks—could
eliminate as much as 90 percent of acquired heart
disease as well as 95 percent of type 2 diabetes (a
leading cause of heart disease).KEY PERSONAL HEALTH FACTORS
ALCOHOLuse cigarette smoking
EATING HABITS occupational and recreational
physical inactivity safety
safer sex practices seat belt and helmet use
substance abuseContemporary Issues and Challenges
Preventive medicine specialists acknowledge the
many challenges of controlling or eliminating the
factors that result in the health conditions that are
most significant at present. Despite the truly phe-
nomenal strides in health care that have occurred
in the past 50 years, the emphasis within the
American health-care structure remains on treat-
ing disease. Factors that influence the success of
prevention measures include cultural and genera-
tional perceptions, literacy and non-English-
speaking populations, aging of the US population,
access to care and mechanisms of care delivery,
and disparities among population groups.
Cultural and generational perceptions Percep-
tions about health screening, preventive care, and
even treatment for diagnosed health conditions
differ among cultures and age groups. Older gen-
erations may hold to beliefs that one goes to the
doctor only when ill or injured, stemming from
limited access and affordability that typified health
care before the emergence of health insurance.
Ethnic groups may be suspicious of Western medi-
cine and its intrusive nature or find conventional
medical practices at odds with spiritual or religious
beliefs.CULTURAL AND ETHNIC HEALTH-CARE PERSPEC-
TIVES and GENERATIONAL HEALTH-CARE PERSPECTIVES
greatly influence compliance with public health
recommendations, affecting groups that are partic-
ularly vulnerable to health conditions, such as car-
diovascular disease or infections such as hepatitisPreventive Medicine 3