It is a paradoxical government that pays farmers to grow tobacco, warns citizens of its dangers, and supports medical care for those who choose to use tobacco. It is also a paradox that this nation spends billions of dollars to treat diseases arising from environmental pollution, poor nutrition, stress, and toxic waste, and spends very little on prevention.
Streams, lakes, and oceans are giving clear messages that the food chain is being irreparably damaged, yet nothing is done about it. Science has eradicated small pox, prevented polio, diphtheria, and whooping cough, but it can not cure the common cold. Antibiotics can cure bacterial infections but viruses are becoming more deadly.
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| Health Promotion |
Payment is made to a health delivery system for illnesses incurred, not for maintenance of health. Medicine does not equal health, yet physicians earn considerable salaries, vast prestige, and millions of research dollars, whereas those involved in prevention gather little recognition. In fact, the physician who knows less about the whole patient may have more status and collect larger fees (e.g., the cardiologist versus the family practitioner).
Another paradox is that illness can be defined and measured by morbidity and mortality tables; health is more complex, and often defined as the lack of illness. Although life expectancy rates are increasing, is it not because of better health, but because bacterial infections are not fatal, nor are there wildfire pandemic diseases such as the plague.
Another paradox is that illness can be defined and measured by morbidity and mortality tables; health is more complex, and often defined as the lack of illness. Although life expectancy rates are increasing, is it not because of better health, but because bacterial infections are not fatal, nor are there wildfire pandemic diseases such as the plague.
Widespread problems arise from lifestyle problems, stress, poor diet, smoking, the use of alcohol and other drugs, lack of exercise, and pollution. The Surgeon General`s office estimates that as much as half of the United States mortality is due to unhealthy behavior or lifestyle; 20% to environmental factors. Thus while the population looks to medicine to cure the disease, the true cure lies in behavior changes that are difficult to accomplish.
It seems easier to cope with a coronary bypass than it is to eat sensibly, exercise regularly, and abandon smoking. Humans engage in magical thinking, believing that they will know when they are about to become ill so that they can give up the behavior that is causing it. It seems less expensive to tolerate filthy waterways and polluted air than to restore the environment to healthy levels. Again, as with other health issues, this nation does not have a social policy that can shape the manner in which public funds are distributed.
At present, public funds are invested largely in illness, with miniscule amounts (less than 1% of the health care budget) distributed to health promotion and disease prevention. Yet, while all other consumer prices increased by 1% in 1987, medical costs escalated to 7.7%. in the long run, prevention may be the best investment, with fewer dollars needed and more people served. This works well with the economist`s theory of “more bang for the buck”. The Public Health Research Group estimates that $100 billion is spent each year on preventable illnesses, yet today we have an “...armamentarium of preventive principles that work and work well. Prevention holds significant promise for problems as diverse as stroke, immune disorders, and a huge range of chronic, debilitating disease from pernicious anemia to osteoporosis.
Nor have the health care professions served society well. Ivan Illich states that by transforming pain, illness, and death from personal challenge into a technical problem, medicine expropriates the potential of people to deal with their condition in an autonomous way. Phisicians and nurses have done little to teach the consumer how to stay out of the system, to manage their own wellness, and to live healthier lifestyles. Nursing in particular has health as a primary agenda and should be on the forefront of health promotion, yet the majority of nurses do not assume that responsibility. Even worse, they do not see health as an area of expertise.
References :
Berger S : What you doctor didn`t learn in medical school, New York, 1988, William Morrow & Company, Inc.
Illich I : Medical nemesis, In P Lee, N Brown, and I Red, eds : The nation`s health, San Francisco, 1980, Boyd and Fraser Publishing Co.
Grace L. Deloughery, Issues and Trends in Nursing, 1991, Mosby Year Book, St. Louis, Missouri.
