Ecological Public Health: Reshaping the Conditions for Good Health

Johnson, Anne

Hardy, Anne

Varkey MD Mph Mhpe, Prathibha

Everyone knows the old adage, "an ounce of prevention is worth a pound of cure," but we seem not to live by it. In the Western world's health care it is commonly observed that prevention is underfunded while treatment attracts greater overall priority. This book explores this observation by examining the actual spending on prevention, the history of health policies and structural features that affect prevention's apparent relative lack of emphasis, the values that may justify priority for treatment or for prevention, and the religious and cultural traditions that have shaped the moral relationship between these two types of care. <p/>Economists, scholars of public health and preventive medicine, philosophers, lawyers, and religious ethicists contribute specific sophisticated discussions. Their descriptions and claims lean in various directions and are often surprising. For example, the imbalance between prevention and treatment may not be as great as is often thought, and we may be spending excessively on many preventive measures just as we do on treatments compelled by the felt demands of rescue. A standard practice in health economics that disadvantages prevention, "discounting" the value of future lives, may rest on weak empirical and moral grounds. And it is an "apocalyptic" religious tradition (Seventh-day Adventism) whose members have put some of the strongest and most effective priority on long-term prevention. <p/>Prevention vs. Treatment is distinctive in carefully clarifying the nature of the empirical and moral debates about the proper balance of prevention and treatment; the book pursues those debates from a wide range of perspectives, many not often heard from in health policy.

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Viral Vaccines Joseph L. Melnick As with history in general, the history of vaccines needs to be reexamined and updated. My task is to look back to see what has been successful and to look forward to see what remains to be accomplished in the prevention of viral diseases by vaccines. Also, I shall refer to the pertinent material discussed at two recent conferences of the Institute of Medicine, National Academy of Sciences, on virus vaccines under development and their target populations in the United States (1985b) and in developing countries (1986). These reports, plus a third on Vaccine Supply and Innovation (1985a), should be required reading for all those in both the public and the private sector who have a responsibility or interest in vaccines for the prevention of human disease. It has been through the development and use of vaccines that many viral diseases have been brought under control. The vaccines consist either of infectious living attenu- ated viruses or of noninfectious killed viruses or subviral antigens. When we look at the record, it is the live vaccines that have given the great successes in controlling diseases around the world. Examples are smallpox, yellow fever, poliomyelitis, measles, mumps, and rubella.