Perspectives of public health and prevention

The average life expectancy at birth of Americans has increased 30 years since the turn of the century and is mostly attributable to public health measures. Although death rates for cardiovascular diseases have declined in the past two decades, cardiovascular diseases still cause more deaths in the United States than all other causes combined. The major etiologies of heart disease, atherosclerosis and hypertension, are associated with modifiable risk. factors-high blood cholesterol, high blood pressure, cigarette smoking, diet, and inactivity. Social status and access to medical care are also important contributors. Consequently, the greatest potential for reducing heart disease mortality and morbidity rests with prevention and public health practice. Recent directions in health-care reform emphasize fiscal management, medical care, and clinical medicine, and not general health. This emphasis exacerbates policy and financing imbalances between preventive and curative medicine. Consequently, the concept of a health system needs to be designed more rationally to allocate resources that include prevention and health promotion. The Bogalusa Heart Study provides understanding of the early origin of cardiovascular problems and the environmental and lifestyle factors that contribute to development of adult heart disease. To apply this information, public health models of intervention, like the school Health Ahead/Heart Smart program, are needed to address heart disease in the population. Changes in the true determinants of poor health, such as environmental factors and unhealthy behaviors, are the directions for prevention and future improvement in quality of life.