History shows that the dramatic increase in life-expectancy experienced by many countries over the past 100 years is chiefly due to improvements in nutrition, living and working conditions, hygiene and sanitation, with specific medical measures such as drugs and vaccines having a comparatively marginal effect(1). The vital contribution of public health measures in preventing disease is clearly seen by comparing the higher death rates not only in Third World countries(2) but within poorer sections of affluent nations(3).
The improvements in public health were based on human epidemiological studies. These revealed that people who lived in dirty, overcrowded and unsanitary conditions with little food or clean water were much more likely to die of infectious disease. Today , the main killers in Western society are heart disease, cancer and stroke, conditions which are often difficult or impossible to cure. However, by monitoring different groups of people, epidemiologists have again identified the chief risks and shown that these diseases are also largely preventable(4).
In the case of heart disease, the results have been dramatic. Since the 1960s when the United States had one of the highest death rates for coronary disease in the world, mortality has fallen sharply, in line with changes in diet and lifestyle. Specific medical measures had only a small impact, at best(5). Similar results could be achieved with cancer where 80-90% of fatal cases are potentially preventable. The culprits include poor diet, smoking, alcohol, radiation, pollution and occupational hazards such as asbestos(6).
The evidence suggests that the main influences on our health – diet, lifestyle and the environment – are outside the scope of laboratory experimentation. It follows that major advances in health can only be achieved by putting the greatest emphasis on prevention.
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