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