Steps to Staying Well
Routine Recommendations Flow Sheet

Early Preventative Medicine: Infectious Disease, Immunization

In the early part of the century, preventative medicine focused on the predominant cause of illness of the time: infectious disease. Improved environmental conditions in the first half of the century led to a decline in infectious disease and resulted in improvements in infant and early childhood survival.
In Western countries, governmental provisions to control the spread of disease with modern water and sewage systems complemented the success of the medical profession in putting into practice the developing science of immunization. These provisions combine with improved nutrition, better medical care and other factors to make death from infectious disease an uncommon event. This remarkable accomplishment has now brought life expectancy to unprecedented levels and has left non-infectious and chronic disease the major cause of death and disability.

New Strategies in Preventative Medicine

A new set of strategies has evolved to prevent the chief causes of mortality today: coronary heart disease, cancer, stroke and injury. Preventative medicine is based on epidemiologic studies that have identified risk factors for these conditions.
Many of these risk factors are aspects of individual, chosen lifestyles including cigarette smoking (the most important single cause of preventable death), as well as eating, drinking and exercising habits. The patient must take on a larger responsibility of making the necessary lifestyle changes, and the physician must now add the role of health counselor to his/her list of duties.

Personal Health Practices Need to be Addressed

In its 1989 Guide to Clinical Preventative Services, the U.S. Preventative Services Task Force (USPSTF) concluded that "among the most effective interventions available to clinicians for reducing the incidence and severity of the leading causes of disease and disability in the U.S. are those that address personal health practices of patients." In the report, the USPSTF reviewed the evidence for 169 interventions to prevent 60 different illnesses and conditions.
The risk of illness and mortality are not evenly distributed among patients in a single physician's practice. Thus, the need for interventions to promote health and the early detection of illnesses must be individualized. Primary prevention of risk factors, such as smoking, physical inactivity, poor nutrition and alcohol or drug abuse, has a greater likelihood of improving health than secondary prevention, defined as screening for early disease by tests and procedures.

Health Maintenance and Disease Prevention

The following review of health maintenance and disease prevention focuses on the most common causes of death from adolescence to old age.

Cardiovascular Disease

Atheroslerotic cardiovascular disease (ASCVD) is the overall leading cause of death in the U.S. ASCVD causes 1.5 million myocardial infarctions and 520,000 deaths each year. Risk factors include:

• Age
• Sex
• Family history
• Cigarette smoking
• Hypertension
• Stress
• Diabetes
• Obesity
• Medications such as oral contraceptives

Hypertension is a major risk factor for coronary, heart disease, congestive heart failure, stroke and renal disease. Your blood pressure should be recorded on each visit or approximately every 2 years in patients with previously normal blood pressure readings. Ideal blood pressure readings should be less than 130/85.
Smoking is the largest preventable public health problem currently existing in the U.S. (390,000 deaths per year). Smoking accounts for one out of every six deaths in the U.S., over 130,000 of these deaths are due to smoking-related cancers.
In adult men, smoking accounts for:

• 90% of all deaths from cancer of the lung, trachea and bronchus
• 92% of deaths from cancers of the larynx
• 78% of deaths from esophageal cancer
• 48% of deaths from pancreatic cancer
• 17% of deaths from stomach cancer

Smoking is also responsible for over 115,000 deaths each year from coronary heart disease and 27,500 deaths due to cerebrovascular disease. Smoking accounts for nearly 60,000 deaths per year from pulmonary disease, such as chronic airway obstruction. Cigarettes are also responsible for about 1,500 fire-related deaths and 4,000 injuries each year. Total direct and indirect costs of smoking may be as high as $200 billion per year.

CANCER
The second leading cause of deaths in all age groups is malignant neoplasms. The National Cancer Institute (NCI) has summarized by the USPSTF and studies, protocols and guidelines for cancer prevention and detection. Because of differences in goals and methods used by these groups, these groups offer different recommendations to practicing physicians. NCI's goal is to reduce overall cancer mortality by 50%. The NCI guidelines focus on detecting cancer in the person without symptoms.
The USPSTF systematically assesses the effectiveness of clinical preventative services in terms of the adequacy of supporting data. Inadequate evidence was found by the USPSTF to document the efficiency or define the optimal interval for performing a large number of preventative services.

INJURY
Injury is the most common cause of death in persons below age 40 and 4th most common cause of death in person in all age groups. Motor vehicle accidents cause about one half of those deaths. Only 46% of Americans use seat belts. Properly used seat belts decrease the risk of moderate-to-severe injury to front seat occupants by 45%-55% and reduce crash mortality by 40% to 50%.
The third major cause of death in all age groups is homicide and suicide. Some of the factors associated with a high risk for violence homicide include early exposure to violence such as child abuse, violent role models, unstable lifestyle, unemployment, illiteracy, substance abuse, low tolerances for anxiety, depression, low self esteem, poor impulse control, and easy access to weapons. Counseling and providing supportive guidelines may reduce these risks.
This information is not intended to replace the medical advice of your doctor or health care provider. Please contact your health care provider for advice about a specific medical condition.