In fact, international comparisons have shown that health service factors (such as the proportion of the gross national product spent on health, numbers of doctors, nurses, hospital beds etc.) are relatively unimportant in explaining the differences in mortality rates between developed nations: increasing health service expenditure has little effect on mortality which again demonstrates that the main determinants of longevity are lifestyle and environmental rather than medical.25 Indeed, the studies have shown that it is differences in living standards which are most crucial in explaining international variations.
The disastrous effect of relying on treatment to the virtual exclusion of preventive action is most tragically seen in the field of cancer. Despite progress against some rare forms of cancer, accounting for 1-2% of total deaths caused by the disease, a 1986 report in the New England Journal of Medicine found that the overall death rate in America had increased substantially since 1950. “The main conclusion we draw”, the authors stated, “is that some 35 years of intense effort focused largely on improving treatment must be judged a qualified failure.” The report further concluded that “we are losing the war against cancer” and argued for a shift in emphasis toward prevention if there is to be substantial progress.26
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