PRIMARY PREVENTION

AN ESSENTIAL COMPONENT OF A NATIONAL AGENDA

“Unhealthy behaviors have been estimated to be the proximal  cause of over half of the disease burden in our country.”

-----------NIH Director Elias Zerhouni, M. D.

Institute of Medicine figures suggest that 95% of the U.S. research and development portfolio is devoted to treatment, while only 5% is geared toward health protection.

The report of the National Commission on Digestive Diseases presented to Congress over 30 years ago, recommended that a proactive clearinghouse be established to reach out to intermediaries about digestive diseases and their prevention.  However, budget constraints experienced at that time were responsible for the current guidelines for the Clearinghouse that precluded a proactive health promotion agenda.

In the mid '70s, alcoholism was thought to be the primary cause of 75% of  liver related disease and deaths.  Medical school agendas contained little information about the physiology and pathology of the liver; there were no treatments and few diagnostic measures available.  This lack of information about the liver was also evident in schools.  Children were learning about their heart, lungs and kidneys, but nothing about the importance of their liver and how it could be severely damaged by activities they might be participating in their daily lives.

 Today, viral hepatitis has replaced alcohol related cirrhosis as the major cause of liver related deaths.  Alcoholic liver disease and viral hepatitis are all related to participation in unhealthy risk behaviors. Because the liver is a non-complaining organ, it is a challenge to create interest in this vital organ and to alert the public about ways that it can be severely damaged with little or no warning.

 Outstanding informational brochures about liver diseases have been created by the Clearinghouse to enable those who are affected by one or more of the l00 diseases that attack this vital organ to understand their illness.  However, little is available to promote the importance of developing healthy lifestyle behaviors that protect the liver.   Unfortunately, we can not expect individuals to change what they do not know. 

Research awards are lacking to provide evidence based data to prove that understanding the importance of the liver to their health and wellbeing is an effective approach in preventing viral hepatitis and activities, (i.e., substance abuse and sexually transmitted diseases), that contribute to the major burden of these diseases in healthcare costs and lives lost.

Information about the liver is still lacking in schools.  Time allotted to health education is extremely limited.  Where do adults obtain their  health information?  Knowledge is the key to prevention.  However, knowledge is not enough.  Techniques of using that knowledge to affect change is a basic need and sharing that knowledge to motivate others is essential.

We are fortunate that many liver diseases are preventable. Other diseases of the digestive system are less fortunate. Yet, much needs to be done at the national level to be certain information vital to the prevention and control of all digestive disease is made available to the gatekeepers working on the front lines with children and adults including teachers, nurses, physicians and, of course, parents.

It is easier to build a foundation of knowledge and prevention than it is to rebuild a life destroyed by ignorance.  Prevention cost money, but ignorance costs more.