The Prevention Agenda: Missing the Forest for the Trees

All the fancy technology to define the disease in coronary arteries leads to nothing that can be shown to save lives or spare one from symptoms. As for the next episode of musculoskeletal pain, the most scientifically supported advice is to get on with life; this too shall pass.

However, the public health agenda will have us all screened. The public health agenda will have us all wary, concerned and medicalized. The public health agenda will have more and more of us undergoing various forms of biopsies with no yield.

More and more of us will be swallowing drugs to lower blood pressure, lower cholesterol and lower blood sugar as well as keep the calcium in our bones. More and more of us will have some form of surgery on our coronary arteries. And more and more of us will bear the stigmata of surgical hubris about our knees, shoulders and backs. All this may be done more efficiently, perhaps more expertly, and perhaps at a reduced cost per person, but don't for one minute think you, the public, or the public coffers will be better off.

There is a major treatable risk factor that remains unspoken in all the prevention advice, marketing and background noise. The most important risks to longevity, and to quality of life, lurk in one's station in life.

Beware if you can not find a niche that affords some sense of satisfaction, an element of comfort, and hint of pride. Whether we measure this by socioeconomic status, by neighborhood, by education, by job satisfaction or by job security, if you are not comfortable in your skin it will cost you five to 10 years on this planet. You are at risk of dying from something, "all-cause mortality", well before your time. It doesn't matter if you are "thin" and have normal blood pressure, blood sugar and cholesterol. For you, 75 is old; for those who are comfortable in their skin, 85 is old.

Some of you who started life with few advantages and in a poor neighborhood have been able to move up in society. You have done much for your quality of life. You have also improved your longevity. But you will not catch up to those whose biology was not tainted by a passage through poverty.

Some of you who have spent most of your life nurtured by and nurturing the comfort and pride that come with a solid position in society now find yourself without job security, or even a job. In addition to all the turmoil in your life, you have acquired turmoil in your biology that is a kiss of earlier death.

We only have theories, many theories, as to the biology that determines all-cause mortality, the timing of the time of your death. But the public health message is clear. We will serve the health of the public far more by fostering effective educational programs and providing nurturing occupational opportunities than by any assault on fried foods or coronary arteries. A kinder and gentler America is a public health agenda.

Dr. Nortin Hadler is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and an attending rheumatologist at University of North Carolina Hospitals. He is the author of "Worried Sick: A Prescription for Health in an Overtreated America," and "The Last Well Person."

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