MORE ABOUT PREVENTION: CATEGORIES OF PREVENTIVE MEDECINE
Preventive medicine can be divided into three categories.
Primary prevention involves the removal of causes so that the condition doesn’t occur in the first place. Diseases related to smoking are obvious examples here: stop people smoking (primary prevention) and the smoking-related diseases disappear.
Secondary prevention picks up disease before symptoms occur. This is the essence of health screening which, by detecting disease early, can prevent the development of more serious manifestations of the disease. Detecting previously undiagnosed high blood pressure is a good example of this kind of prevention.
Tertiary prevention involves the management of diagnosed disease in such a way as to prevent or limit the development of a disability or to prevent the person dying prematurely. The best example here is diabetes. Diabetics with good tertiary prevention can now live long and near-normal lives.
But what are we aiming for with all the prevention-eternal life? No. Most people, when asked, are happy to settle for a reasonably long lifespan spent in good health. In simple terms medicine over the last hundred years or so has shifted deaths in early years to later life. However, despite a four-fold increase over the last century in the number of men living to be 100 and a nine-fold increase in the number of women living to that age, the proportion is still only one in 1,000 and 5 in 100 respectively. Suggestions that we could all live to 130 or more are as yet somewhat fanciful but we can now reasonably aim to live to about 85 or 90, with few of us dying of disease under the age of 70. If we are to achieve this we have to attack cancers and heart disease, which account for more than half of all life lost under the age of 85, and those few diseases that stand out as special cases. These include diseases associated with the excessive use of alcohol, addictive drugs, motorcycles, cigarette smoking in women and large numbers of sexual partners.
But being healthy is not just a matter of what you do or do not do. It seems that health and long life are often a gift bestowed on a person at conception when they inherit good genes. With the combined effects of healthy habits and good luck many people’s health can be maintained for years with good medical care taking the edge off diseases and accidents. Until fairly recently, living longer usually meant accumulating more and more disorders, diseases and disabilities which, together with social isolation, poverty, failing memory, a loss of purpose, reduced family contacts and other limitations, have led to a vast increase in the numbers of elderly people living out the last years of their lives in residential care. Younger people, seeing this as a depressing future for themselves, are beginning to get concerned-and rightly so. A questionnaire in a Swedish magazine in 1971 asked readers how they most wanted to did A large majority said they wanted to pass away quickly and without worrying. So, ironically, what we are all trying so desperately to prevent-heart disease – appears to be exactly what, in one form, many of those ‘at risk’ most want to die from. But as in the old monk’s prayer-’Dear Lord, give me patience; but give it to me now’-we can’t choose when this sudden and quick form of death will take us. None of us would mind dying like this in our seventies or eighties but the tragedy is that increasing numbers of men in their forties or fifties are losing their lives in this way.
Some people worry about the long-term effects of a population with an ever increasing proportion of ever older people, and they have a point which has to be taken seriously by those who try to prolong life at almost any price. Viewed in the widest possible socio-economic perspective, the gradual move from a three-generation society to a four-generation one is likely to produce increasing strain between the productive and reproductive groups and those who are mainly ‘takers’ from society. Our industrial society cannot find enough jobs for its working-age people, let alone the elderly. So we could soon see countless millions of pensioners in the western world with many years of life to live but with nothing to do.
No one would dispute the benefits preventive medicine has brought in the earliest part of life but, some people are asking, should it be allowed to do the same for the other end of the life scale – at least in those societies where already those who reach middle age tend to live into their eighties? All of this may appear somewhat pessimistic but it could well be that within the reasonably near future the elderly will be taking up so much of the nation’s resources that curative medicine for the productive sector of society will be seriously put at risk. There are those who would say that this is already happening, at least to some extent.
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