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ditions as thickening of the coronary arteries, high blood-pressure,
diabetes and arthritis (attributable to excessive wear and tear of the
joints, principally the knees), is well recognised; and the growing
concern in relation to alcoholism is reflected in the recent Government
decision, announced in Parliament on 11th November by the Secretary
of State for Social Services, to allocate an additional £2 million over
the next four years to improve facilities and advice for alcoholics.
Accidents, poisoning and violence are responsible annually for one
death in every twenty-five and in this group accidental deaths in the
home and on the road, and suicide, feature prominently; in fact accidents
and violence constitute the commonest cause of mortality in
children over a year old and under the age of fifteen. In spite of an
increasingly high standard of ante-natal care, obstetrics and anaesthetic
skill, and paediatric supervision, some 3% of all deaths still occur in
infancy, mainly in the first month. Premature birth is a major factor
in nearly two-thirds of stillbirths and deaths within the first week of
life; much remains to be learned about the causes of prematurity and
this is an extremely important field for research since survivors of
premature births have a high incidence of physical and mental handicap.
Finally, it is pertinent to note that infectious disease—for so many
centuries the commonest cause of death—now accounts for less than
1 % of the overall mortality, thanks to the efficacy of modern means of
immunization and treatment coupled with a greatly improved state of
nutrition generally.
Equally striking in highlighting the relevance of prevention are the
statistics relating to sickness absence amongst the working population.
Some 300 million working days are lost each year on account of
illness and nearly one-ninth of these are attributable to bronchitis.
Other major causes of sickness absence comprise mental illness;
accidents, poisoning and violence; arthritis, lumbago and rheumatism;
diseases of the heart and circulation; and disorders of the stomach and
duodenum.
Thus an examination of the major causes of mortality and morbidity
reveals only too clearly the opportunities for prevention through the
exercise of personal initiative on the part of the individual—by
eschewing unhealthy habits, seeking specific protection in the form of
vaccination and immunization, and taking full advantage of available
facilities for medical advice and care including screening—and of the
community in implementing public health programmes to improve the
environment, to detect disease and disability, and to give support to
both doctor and patient. The need for intensive health education is
paramount.
To be effective health education must not be portrayed as a mere
denial of pleasure or series of admonitions for such a negative approach
invites and merits failure. Rather is a positive emphasis on personal
achievement needed—the satisfaction of running a short single in
middle age for example! In a free society the ultimate responsibility
rests—and rightly so—with the individual who is entitled to know the
facts and to make a personal decision in the light of current knowledge.
As a corollary the community has a special duty to ensure that
the young, whilst still at school, have the opportunity to learn about
keeping fit and healthy before acquiring habits which they may later
regret.