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cases and the primary prevention of cancer of
the lung now running at 30 000 deaths a year in
persons under 65 years of age in this country
can be accomplished on a drastic scale if
people, particularly the young, could be
persuaded not to smoke or to cease from smoking
Ischaemic heart disease including coronary
thrombosis is reaching proportions particularly
in early middle aged men when it could be
described as a modern epidemic. I shall quote
from the preface of my 1965 annual report as
medical research in the intervening period
supports what was written more firmly In the
present stage of medical knowledge it may be
said that heart attacks may well be reduced in
number if each person balances his work,
exercise rest and play, takes animal fats and
sugar in moderation, keeps his weight correct
for his height and does not smoke. Those who
have a family history of coronary disease or
are significantly overweight could, with
advantage have occasional medical checks in
middle age even in the absence of symptoms'
Secondary prevention is the very early
recognition of disease at a stage when no
permanent or irreversible damage has been done
and when by prompt treatment the person can
be restored to health
Into this category comes the screening of
populations for early undetected disease such
as for the precursor of cervical cancer by
means of cervical cytology Here a person may
be prevented from progressing from a minor to
a far more serious disease and in fact be
restored to health
Mass radiography has in the past detected
much disease at a stage when treatment is
effective
Child health clinics and the developmental
assessment of all young children with special
attention to those on an observation register
are all procedures to effect early recognition of
disease and so prevent chronic disease
The conservation of teeth by the treatment
of caries where primary prevention has failed
is another example of secondary prevention
where function is returned to normal
The treatment of obesity is again a good
example of secondary prevention in that the
patient concerned may be saved an enormous
amount of chronic ill health and can if
treated early enouth be returned to a state of
normal health It must be remembered that
obesity figures in most of the major causes
of death in this country.
Any surgical procedure which returns a
person to normal health is an example of
secondary prevention
Tertiary prevention is the description
given to the effective treatment of established
disease in order to prevent further degeneration
or additional complications For example the
effective control of diabetes meilitus helps
to prevent cardiovascular complications When
diseases such as bronchitis hypertension and
heart disease have slipped through the net of
primary and secondary prevention they are
often so advanced that only tertiary prevention
is left Here medical science attempts by
every means in its power to hold back the
progress of the disease as long as possible,
but the condition is by this time incurable and
the patient cannot be restored to full functional
health
Thus all parts of the health service, the
general practitioner teams, the hospital and
health authority staffs have varying parts to
play in primary secondary and tertiary
prevention and cannot logically remain
administratively or functionally separated
In Hounslow we have appointed a health
educator and an ambitious programme of health
education in our schools is under wav From
the above examples it can be seen that
education of the public has a tremendous part
to play particularly in primary and secondary
prevention In the short term it will lead to an
increase in demand for health supervision and
care by increasing the awareness of the public
In addition demand for health facilities for
chronic disease will continue to increase as
the ranks of the elderly are swelled by those
saved from accident and disease in preceding
years but not safeguarded from the diseases
of old age In the long term however health
education particularly in primary prevention
could reduce demand in certain areas if the
young could be motivated to move willingly and
freely along the paths of healthy living and be
taught to avoid pointless flirtation with disease
A healthier generation could then conceivably
pass more smoothly through a healthier middle
age into a healthier and more productive old age
More must be learnt about the mysteries of
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