I thought the article first sent was interesting, although I don't agree with all of his points. I do agree with some of his points regarding the current public health education and practice.
However, what you just sent is not a fair description of what public health has evolved. We (the developed countries) as a society and the world as a whole has moved more to rare diseases as opposed to communicable (infectious) disease, although some of the rare disease may still have infectious etiology. However, the issue here is not the occurrence of the disease, but the lost of quality of life, and the health care of diseases.
In the old days, with highly communicable diseases when death rates were high, people died, there were emotional costs associated with it, and definitely the loss of productive life (in the "industrial" sense, because one died, one lost days to be productive, "to make money" and "to contribute to the society".) However, other than that, there was not a "huge" cost to the society where you have a high birth rate. So to be "logical" and "rational" about this, there is a balance of birth and death.
Today, as we all know, in the developed/post industrial society, you have people living longer with a stable or declining birth rate. And many of the "rare diseases" are also associated with age (cancer, heart diseases, COPD, Alzheimer's diseases). One can have AD at late 60s or 70s, and don't die until in their 80s or 90s. In addition, we are seeing people with not just one health conditions, but multiple. People who have diabetes are also more prone to hypertension and leading to heart diseases. So there are incentives for the society as whole to invest in the prevention of these illnesses. You are talking not about people dying, but people living longer with these diseases and need health care resources.
Therefore, if we really want to talk about a reform of public health, we need to move beyond thinking mortality. People don't die as much, but they sure live longer. But what is the quality of that life? Of course of prevention strategies need to take into consideration of multiple/global determinants of health. I hear a lot of people talking about it, but who's implementing it?
>>> Dennis Raphael <[log in to unmask]> 11/05/07 3:53 PM >>>
"Smoking causes lung cancer, right? Then, out of a hundred 35-year-old men
who smoke cigarettes, many will die of lung cancer by age 70, right? The
answer is no: On average, only eight of them die of lung cancer. Fruit and
vegetable consumption will lower your risk of lung cancer if you smoke
cigarettes, according to a recent study published in the American Journal
of Epidemiology. So, persuade smokers to eat fruits and vegetables and you
would lower the rate of lung cancer, right? Perhaps, yes; but about 25,000
people would have to change their diet to eliminate as few as 25 cases a
year. Most diseases, even dreaded ones like lung cancer, breast cancer, or
AIDS, are extremely rare. You can do something that raises by quite a lot
the chances of getting a disease and still be very unlikely to contract
it.
Academic epidemiologists are especially culpable here. In the rush to
publish, we have become accustomed to advertising the most inconsequential
research findings as if they were earth shattering. And we fail to point
out that most diseases remain rare, even when people do what their mothers
cautioned them not to. We never tell the whole story: that most smokers do
not die of lung cancer, most bicyclists who ride without helmets do not
die of head injuries, most people who have sex without a condom do not get
AIDS. No wonder people think that their individual behavior is paramount
in deciding whether they will get sick or stay healthy.""
http://www.ph.ucla.edu/EPI/bioter/shattermyth.html
Of related interest:
Poverty and Policy in Canada: Implications for Health and Quality of Life
by Dennis Raphael
Foreword by Jack Layton
http://tinyurl.com/2hg2df
Staying Alive: Critical Perspectives on Health, Illness, and Health Care,
edited by Dennis Raphael, Toba Bryant, and Marcia Rioux
Foreword by Gary Teeple
http://tinyurl.com/2zqrox
Social Determinants of Health: Canadian Perspectives, edited by Dennis
Raphael
Foreword by Roy Romanow
http://tinyurl.com/yptzae
See a lecture! The Politics of Population Health
http://msl.stream.yorku.ca/mediasite/viewer/?peid=ac604170-9ccc-4268-a1af-9a9e04b28e1d
Also, presentation on Politics and Health at the Centre for Health
Disparities in Cleveland Ohio
http://video.google.com/videoplay?docid=-4129139685624192201&hl=en
Dennis Raphael, PhD
Professor and Undergraduate Program Director
School of Health Policy and Management
York University
4700 Keele Street
Toronto ON M3J 1P3
416-736-2100, ext. 22134
email: [log in to unmask]
http://www.atkinson.yorku.ca/draphael
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