Prevention: A World Health Strategy
by James L. Morrison

[Note: This is a re-formatted manuscript that was originally published in On the Horizon, 1993, 1(5), 5-6. It is posted here with permission from Jossey Bass Publishers.]

The 20th century has seen unprecedented gains in human health and survival, with average life expectancy for newborns worldwide doubling from about 30 years in 1900 to 64 years in the late 1980s. The world-'s elderly population will swell by 114% between 1990 and 2020; by 2020, 67% of the 706 million persons over age 65 will live in lesser developed countries (LDCs). A revolution in health strategy is required to address the health challenges of the late 20th and early 21st century (e.g., sexually transmitted diseases, HIV, and smoking).

In the first three decades after WWII, the major thrust of health programs was biomedical and technical. By the 1970s, there was growing evidence that a hospital-based, curative strategy was failing to meet health needs and was increasingly expensive. In wealthy countries, it became increasingly apparent that many chronic diseases among adults resulted from unhealthy behavior, diet, and lifestyle, Many of these countries have developed strategies for encouraging healthy lifestyles, in an attempt to resolve this problem.

In LDCs, it became clear that the Western medical model of urban-based hospitals was not meeting health needs. A few LDCs have focused their health systems on reaching all the people with essential services, and promoting basic hygiene and good diets.

The international donor community translated the primary health movement into a global child-survival strategy. Promoting healthy lifestyles and child survival should be looked at as precursors of a revolutionary shift in worldwide health policy and program strategy. The preventative approach to improving health recognizes that all sectors of society must be involved in the production of health.

[Mosley, W.H. & Cowley, P. (1991, Dec) The challenge of world health. Population Bulletin, 46 (4), 1-39. Adapted from Future Survey, (1992, Nov).]

Cancer Prevention: A Change in Lifestyle

Cancer is now the leading cause of death for women in the US. If trends continue, it will be the leading cause of death for both men and women by 2000. This is not so much due to the cancer mortality rate (which has increased by a modest 6% between 1950 and 1987) but to the remarkable and consistent decline in heart disease mortality (which has fallen 55% of its rate in 1950) resulting from reduced prevalence of major risk factors.

Recently there have been major changes for some individual cancer types. Since 1973, mortality caused by Hodgkin's disease, and cancers of the cervix, uterus, stomach, rectum, testis, bladder, thyroid, oral cavity, and pharynx has declined more than 15%. These decreases are believed to result from changes in food preservation practices and consumption patterns, as well as early detection and treatment. Since 1973, increases in mortality of more than 15% have occurred for lung cancer, melanoma, non-Hodgkin's lymphoma, and multiple melanoma. Increases in incidence of more than 15% (but not in mortality) have occurred for kidney, prostate, breast and brain cancer. (The increase in brain tumors is largely explained by CAT scanners that diagnose otherwise "silent" tumors.) Tobacco, alone or in combination with alcohol, remains the most important cause of cancer, accounting for about 1 in 3 US cases. There is sufficient knowledge to move energetically toward the prevention of a significant proportion of human cancer. Contrary to popular opinion, environmental pollution is not a major cancer hazard. The majority of cancer causes (tobacco, alcohol, animal fat, obesity, ultraviolet light) are associated with lifestyle.

[Henderson, B.E., Ross, R.K., and Pike, M.C. (1991, Nov). Toward the primary prevention of cancer. Science, 254, 1131-1138. Adapted from Future Survey (1992, Nov).]


Both of these books imply that prevention is a major international health strategy that opens the door to new collaborations between the social sciences and the biomedical sciences. Many of the world health problems will not be resolved without social change. For example, research on iron deficiency in rural Chinese children has shown that government interventions have been ineffective because of pervasive fears of genocide in the minority population. While the intervention is simple and effective (e.g., the introduction of salt tablets to the diet) the social obstacles are enormous. This medical condition will only be resolved when a socially acceptable intervention is devised.

A similar situation is found for heart disease, AIDS, and lung cancer in the western world. For example, we have the knowledge to significantly reduce the incidence of these conditions, but we lack the social knowledge and/or the social will.

How does this affect higher education? Proactive colleges and universities must assume their responsibilities and develop opportunities to facilitate the interdisciplinary interchange to solve these problems. Duke University, for example, has established the Center for Living, a multidisciplinary research and intervention program to reduce the incidence of heart attack. Individuals at risk are referred to the Center where social and medical issues are addressed in an integrated "holistic" approach.

Institutions of higher learning have a responsibility to their students to raise the consciousness of personal health issues and personal decision making so that the next generation can appreciate the health risks involved in individual behavior. This is simply one piece in the larger picture of social responsibility.

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