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Preventive medecine: what can individuals actually achieve? PREVENTIVE MEDECINE: WHAT CAN INDIVIDUALS ACTUALLY ACHIEVE?
Preventive medicine is probably imbued with more rhetoric and noble ideas than any other medical speciality, but amongst all the high-flown talk one assertion stands out-that people ought to be more responsible for their own Health. This argument suggests that if we were all more 'responsible' and 'pulled ourselves together' we could prevent much illness both in ourselves and others. I personally find this a naive and unhelpful way of looking at prevention because it puts too great a burden of responsibility on millions who can't cope with it. If they then 'fail' they are double losers-not only do they have the health problems to deal with but they are deemed to have brought them upon themselves.
The idea that personal lifestyle has implications for health is very old indeed. It underlines many of the injunctions of the Old Testament. The golden rule formulated by Juvenal (a healthy mind in a healthy body) was intended to achieve both physical and psychological well-being simultaneously. Even during the eighteenth and nineteenth centuries when real strides were being made in preventive public health Measures, novels of the day suggested that it was the responsibility of individuals to look to their own well-being.
The idea that an individual can prevent the occurrence of illness is not new, then. What we now understand better is that human behaviour is not simply a matter of what people can will themselves to do-it is the combined result of forces acting from within (many of which are unconscious) and without. So today we can look in a very different way at how human behaviour affects health. No longer can we condemn people on 'moral' grounds for their lack of control, or whatever, and punish them, however unconsciously, with ill health. Also, the almost total control of mass infectious illnesses and the increase of chronic diseases as a cause of death makes the whole business of prevention even more important because the latter are so difficult or even impossible to cure.
This has all led to a generally held assumption that the next great milestone in medical advances will be a wholesale change in personal health-related behaviour brought about by a better understanding of human beings as a result of the behavioural sciences. If this is so and if it is to form the basis of preventive medicine for the future we ought to look at it more closely.
We have looked at health and illness behaviour in some detail already. Obviously an understanding of the subject is crucial if we are really to make any progress in preventing anything. The key study in this area has resulted in the Health Belief Model which attempted to explain how and why people used preventive services such as ÒÂ screening, dental check-ups and vaccinations. Since this model was first developed in the US in the 1950s numerous studies have classified areas touched on by the Model.
The Health Belief Model, simply stated, proposed that in the presence of certain triggers to take health action the likelihood of action actually being taken depends on the person's belief about the seriousness of the health condition, his or her susceptibility to it, the efficiency of the proposed action and the difficulties he or she might encounter in attempting to carry out the action. This, then, is a rational model of human behaviour in which people respond to given situations with thought and with some knowledge.
Unfortunately, even this simple analysis of what happens is fraught with problems, and when we look at a specific example it begins to fall apart. For example, studies have found that women who are relatively young and well educated and have higher incomes are more likely to hold beliefs that are appropriate to taking action to have a cervical smear test than are women with less education and lower incomes. It is obviously not satisfactory to rely on any particular group's own perception of health risks and the advisability of preventive action. The facts, alas, are often that the very groups who are least able to perceive the value of a preventive measure are those most at risk.
The next challenge then is to understand why people believe what they do and to try to find out how their attitudes can be changed to their advantage. In a free society this is a complex business because the people concerned have first to be convinced that a particular health goal is worth achieving. Many approaches are possible and an oblique one often works better than a full-frontal one. For example, many men happily take exercise because it makes them feel good yet they are blissfully unaware of the positive health benefits of their actions. These are purely a bonus to their sporting activities.
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