Day 213 -- can disease be prevented?

On Friday I was preparing a section for a fall course. This dealt with personal behaviours that might enhance or detract from health and well-being. I continue to struggle with the use of the term "disease prevention." Generally this is used in relation to chronic diseases such as heart disease, some cancers, osteoporosis and may even include obesity -- chronic relates to the long term development of these conditions rather than the quick onset of an infectious disease such as influenza. Can we truly prevent disease?  Even a vaccine is not a 100% guarantee against an infectious disease. So -- phrases such as 'chronic disease prevention' might better be termed 'chronic disease risk reduction.' This will be a discussion with the class in early September. I want them to know why I choose to use terminology that is different than the text books and practice environments. To me, words carry meaning and prevention to me means that we can stop something from happening. As health professionals, we may want to do this, but in reality we can't.

Perhaps the reason for my distress with this terminology lies in the 'black-white' dichotomized world such phrases represent. Some people call my concern 'being picky' or arguing over semantics,  but to me it is the need to be correct. As health professionals do we not have an ethical responsibility to be truthful with people? This type of language also implies that there may be a simple way to stop disease. Again, this does not occur in reality. Common health wisdom recommends that people choose not to smoke, eat a balanced diet, limit alcohol, sodium, and sugar intake and so on. Each of these behaviours does not stand on it's own -- they are intricately intertwined in a complex web of personality, economics, culture, health status, physical activity, social norms, policy, and many other factors -- determinants of health.  So -- back to the question, does 'disease risk reduction' better reflect what people are working towards?

The song that came to mind while pondering this yesterday may be one that I use in class to help students to see the inter-related nature of health behaviours in a bit of fun way. The lyrics definitely speak to this. Enjoy!

I only smoke when I drink --Small Town Pistols