Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 2
Overview of Prevention
The field of public health has long recognized the imperative
of prevention to contain a major health problem (IOM, 1988). The principles of
prevention were first applied to infectious diseases in the form of mass
vaccination, water safety, and other forms of public hygiene. As successes
amassed, prevention came to be applied to other areas of health, including
chronic diseases (IOM, 1994a). A landmark report published by the Institute of
Medicine in 1994 extended the concept of prevention to mental disorders (IOM,
1994a). Reducing Risks for Mental Disorders evaluated the body of research on
the prevention of mental disorders, offered new definitions of prevention, and
provided recommendations on Federal policies and programs, among other goals.
Preventing an illness from occurring is inherently better than having to treat
the illness after its onset. In many areas of health, increased understanding of
etiology and the role of risk and protective factors in the onset of health
problems has propelled prevention. In the mental health field, however, progress
has been slow because of two fundamental and interrelated problems: for most
major mental disorders, there is insufficient understanding about etiology
and/or there is an inability to alter the known etiology of a particular
disorder. While these have stymied the development of prevention interventions,
some successful strategies have emerged in the absence of a full understanding
of etiology.
Rigorous scientific trials have documented successful prevention programs in
such areas as dysthymia and major depressive disorder (Munoz et al., 1987;
Clarke et al., 1995), conduct problems (Berrento-Clement et al., 1984), and
risky behaviors leading to HIV infection (Kalichman et al., in press) and low
birthweight babies (Olds et al., 1986). Much progress also has been made to
prevent the occurrence of lead poisoning, which, if unchecked, can lead to
serious and persistent cognitive deficits in children (Centers for Disease
Control and Prevention, 1991; Pirkle et al., 1994). Lastly, historical
milestones in prevention of mental illness led to the successful eradication of
neurosyphilis, pellagra, and measles encephalomyelitis (measles invasion of the
brain) in the developed world.
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