PREVENTIVE
MEDICINE
7, 439-441
(1978)
EDITORIAL
Preventive
Health?
ROBERT D. SPARKS W. K. Kellogg
Foundation,
400 North Ave., Battle Creek, Michigan
49016
Preventive health? Do we really intend to prevent health? Of course not, but that is what we are saying in our casual jargon of medicine and public health. Such non sequiturs and other lesser linguistic offenders may be more harmful to promotion of programs and activities for health than we have acknowledged. What understanding do we expect of the public and their representatives in legislatures in response to such phrases? I think we should expect confusion. Furthermore, I think we are getting confusion. The nonsensical phrase, preventive health, arises from giving a single label to a combination of activities which are properly stated separately. The components of the phrase are prevention of disease and maintenance or promotion of health. At any point in discussions, development of programs, or presentation of services, we mean one or the other, but generally not both. When we expound, we should be explicit about whether we are considering health promotion or preventive medicine. If we wish to discuss both, then take the time to say so. Lumping of the two terms inappropriately as preventive (sometimes preventative) health has confused efforts to seek greater commitment of the public to disease prevention or health promotion. Disease prevention does cover a wide range of actions carried out by a variety of medical personnel. Immunizations to prevent measles, whooping cough, poliomyelitis, etc., have been understood as a part of disease prevention. And sanitary controls applied to water supplies, sewage disposal, and processing of milk have also been understood as efforts to prevent disease. Are these efforts for preventive health? Of course these actions do not prevent health: They prevent disease. Health maintenance and health promotion involve efforts which are not as clearly understood by the public or by health professionals. Periodic general examinations, represented in extremes as executive physical examinations or surveys of employees, are understood for their purposes. Selected examinations at regular intervals for abnormalities of the oral cavity, breasts, cervix of the uterus, or prostate are other examples of efforts for maintenance of health which are understood and generally conceded to have value. Programs to promote good health through education of children and adults to encourage good nutrition, reasonable lifelong exercise, and minimizing adverse effects of excess smoking 439 0091-7435/78/0073-0439$02.00/O Copyright All rights
@ 1978 by Academic Press, Inc. of reproduction in any form reserved.
440
EDITORIAL
and alcohol consumption are not always as clearly understood or accepted as measures to enhance personal health and prevent disease. But do these mean preventive health? Not to my mind, which has accepted the conventional delinitions of health, medicine, and disease stated in Webster’s dictionary. The definition given in Webster’s New Collegiate Dictionary for health is: ” 1 a: The condition of being sound in body, mind, or spirit; especially: freedom from physical disease or pain. 2: Flourishing condition.” Furthermore, medicine is defined as: “ 1 a: A substance or preparation used in treating disease. b: Something that affects well-being; 2 a: The science and art dealing with the maintenance of health and prevention, alleviation, or cure of disease; b: The branch of medicine concerned with the nonsurgical treatment of disease.” And disease is defined as: “ 1: obsolete: Trouble; 2: A condition of the living animal or plant body or of one of its parts that impairs the performance of a vital function: sickness, malady; 3: A harmful development .” There is a related offending phrase which is more subjective than the inappropriate preventive (or preventative) health. What does the phrase health care mean? Common usage has permitted the definition of health care to include care of illnesses and services to sustain health of individuals. I can’t argue too much about the combination of these words based upon Webster’s definitions. But I contend that this combination of words has also contributed to confusion of the public about policies, programs, and funding for medical care and health services. The use of the phrase health care permits the listener or reader to make an interpretation of care for acute illnesses or services to preserve public health, whichever suits the purposes of the listener. As a consequence, I believe that the public, and possibly many of their elected representatives, believe that national and local programs for “health care” do provide support for care of illnesses and public health measures to prevent disease. The outcome may be an erosion of programming and funding to support efforts to prevent disease. Wouldn’t the public interest be best served by separating the phrase health care into its two components, medical care and health services? There will be some who advocate that dissection of the phrase into these two divisions is unnecessary and useless. They will speak for maintaining confusion in public legislation about implications of the phrase “health care,” thus permitting flexibility in the use of funds authorized under legislation which uses the phrase. That argument would conclude that the public funds so appropriated could be used either for medical care or health services. In no way can that approach be successful or acceptable. Tax payers do not take kindly to confusion, and they shouldn’t. Is there confusion about the meaning of medical care? Easy answer. These are services provided to patients who have illness or disease. Illness? Disease? It makes no difference for this definition because the common ground is that a person has complaints for which assistance is sought from a health professional. The patient hopes for a cure, or at least a resolution for the problem. But what do we mean by health services? This definition is not so clear and may escape a satisfactorily comprehensive definition. To some individuals and in some programs, it means medical care and more. Health services include services, activities, or programs to prevent disease or promote health. That definition does extend to
EDITORIAL
441
include education which can influence actions of people or groups to protect and improve their health. However, I believe health services should be reserved for activities which prevent disease and promote health, but be exclusive of medical care. That is an opinion which may not have many supporters. But there is a need to distinguish that the greatest improvements in the status of health in populations of the world have resulted from public health measures and if there is a further potential for improvements in minimizing costly chronic diseases and self-induced injuries by new actions to prevent these problems, then we should not permit the issues of medical care and disease prevention to become blurred. I believe the two issues are now confused. It is this confusion which has permitted the lack of commitment in national policy and programming for new efforts to prevent disease and promote health. Elimination of the inappropriate phrase preventive or preventative health ought to be simple. To speak of disease prevention and health maintenance and promotion as separate issues ought to be simple if our understanding of the English language and medical and health problems can be kept clear. Further, we should extend logic and clarity to use of the phrases medical care and health services. Such simple language should be helpful. Could it be worse than it is now?
MEDICINE
7, 439-441
(1978)
EDITORIAL
Preventive
Health?
ROBERT D. SPARKS W. K. Kellogg
Foundation,
400 North Ave., Battle Creek, Michigan
49016
Preventive health? Do we really intend to prevent health? Of course not, but that is what we are saying in our casual jargon of medicine and public health. Such non sequiturs and other lesser linguistic offenders may be more harmful to promotion of programs and activities for health than we have acknowledged. What understanding do we expect of the public and their representatives in legislatures in response to such phrases? I think we should expect confusion. Furthermore, I think we are getting confusion. The nonsensical phrase, preventive health, arises from giving a single label to a combination of activities which are properly stated separately. The components of the phrase are prevention of disease and maintenance or promotion of health. At any point in discussions, development of programs, or presentation of services, we mean one or the other, but generally not both. When we expound, we should be explicit about whether we are considering health promotion or preventive medicine. If we wish to discuss both, then take the time to say so. Lumping of the two terms inappropriately as preventive (sometimes preventative) health has confused efforts to seek greater commitment of the public to disease prevention or health promotion. Disease prevention does cover a wide range of actions carried out by a variety of medical personnel. Immunizations to prevent measles, whooping cough, poliomyelitis, etc., have been understood as a part of disease prevention. And sanitary controls applied to water supplies, sewage disposal, and processing of milk have also been understood as efforts to prevent disease. Are these efforts for preventive health? Of course these actions do not prevent health: They prevent disease. Health maintenance and health promotion involve efforts which are not as clearly understood by the public or by health professionals. Periodic general examinations, represented in extremes as executive physical examinations or surveys of employees, are understood for their purposes. Selected examinations at regular intervals for abnormalities of the oral cavity, breasts, cervix of the uterus, or prostate are other examples of efforts for maintenance of health which are understood and generally conceded to have value. Programs to promote good health through education of children and adults to encourage good nutrition, reasonable lifelong exercise, and minimizing adverse effects of excess smoking 439 0091-7435/78/0073-0439$02.00/O Copyright All rights
@ 1978 by Academic Press, Inc. of reproduction in any form reserved.
440
EDITORIAL
and alcohol consumption are not always as clearly understood or accepted as measures to enhance personal health and prevent disease. But do these mean preventive health? Not to my mind, which has accepted the conventional delinitions of health, medicine, and disease stated in Webster’s dictionary. The definition given in Webster’s New Collegiate Dictionary for health is: ” 1 a: The condition of being sound in body, mind, or spirit; especially: freedom from physical disease or pain. 2: Flourishing condition.” Furthermore, medicine is defined as: “ 1 a: A substance or preparation used in treating disease. b: Something that affects well-being; 2 a: The science and art dealing with the maintenance of health and prevention, alleviation, or cure of disease; b: The branch of medicine concerned with the nonsurgical treatment of disease.” And disease is defined as: “ 1: obsolete: Trouble; 2: A condition of the living animal or plant body or of one of its parts that impairs the performance of a vital function: sickness, malady; 3: A harmful development .” There is a related offending phrase which is more subjective than the inappropriate preventive (or preventative) health. What does the phrase health care mean? Common usage has permitted the definition of health care to include care of illnesses and services to sustain health of individuals. I can’t argue too much about the combination of these words based upon Webster’s definitions. But I contend that this combination of words has also contributed to confusion of the public about policies, programs, and funding for medical care and health services. The use of the phrase health care permits the listener or reader to make an interpretation of care for acute illnesses or services to preserve public health, whichever suits the purposes of the listener. As a consequence, I believe that the public, and possibly many of their elected representatives, believe that national and local programs for “health care” do provide support for care of illnesses and public health measures to prevent disease. The outcome may be an erosion of programming and funding to support efforts to prevent disease. Wouldn’t the public interest be best served by separating the phrase health care into its two components, medical care and health services? There will be some who advocate that dissection of the phrase into these two divisions is unnecessary and useless. They will speak for maintaining confusion in public legislation about implications of the phrase “health care,” thus permitting flexibility in the use of funds authorized under legislation which uses the phrase. That argument would conclude that the public funds so appropriated could be used either for medical care or health services. In no way can that approach be successful or acceptable. Tax payers do not take kindly to confusion, and they shouldn’t. Is there confusion about the meaning of medical care? Easy answer. These are services provided to patients who have illness or disease. Illness? Disease? It makes no difference for this definition because the common ground is that a person has complaints for which assistance is sought from a health professional. The patient hopes for a cure, or at least a resolution for the problem. But what do we mean by health services? This definition is not so clear and may escape a satisfactorily comprehensive definition. To some individuals and in some programs, it means medical care and more. Health services include services, activities, or programs to prevent disease or promote health. That definition does extend to
EDITORIAL
441
include education which can influence actions of people or groups to protect and improve their health. However, I believe health services should be reserved for activities which prevent disease and promote health, but be exclusive of medical care. That is an opinion which may not have many supporters. But there is a need to distinguish that the greatest improvements in the status of health in populations of the world have resulted from public health measures and if there is a further potential for improvements in minimizing costly chronic diseases and self-induced injuries by new actions to prevent these problems, then we should not permit the issues of medical care and disease prevention to become blurred. I believe the two issues are now confused. It is this confusion which has permitted the lack of commitment in national policy and programming for new efforts to prevent disease and promote health. Elimination of the inappropriate phrase preventive or preventative health ought to be simple. To speak of disease prevention and health maintenance and promotion as separate issues ought to be simple if our understanding of the English language and medical and health problems can be kept clear. Further, we should extend logic and clarity to use of the phrases medical care and health services. Such simple language should be helpful. Could it be worse than it is now?
![[Preventive health examinations: conclusions].](/assets/img/hold.png)
