Prevention under the new public health: bioethical considerations

Abstract

Historical transitions in demography and epidemiology have caused important changes in public health policies and programs. One of the most radical transitions has been the move from traditional sanitary strategies to the so-called “new public health”. Well established preventive measures to avoid contagion and spread of infectious diseases were unable to cope with the complex and for the most part little known causes of increasingly prevalent degenerative diseases. At about the same time “Preventive Medicine” was developed as an adjunct to clinical practice, reducing the emphasis of public health care policies and placing the efforts of health care and preventive measures in the realm of the clinical encounter. Physicians were encouraged to provide in depth exploration of the human body, seeking statistical deviations, predispositions and pre-clinical conditions, which allowed the configuration of the “healthy patient” who was educated and encouraged to take up self-caring life styles and habits, as well as preventive medication. Risk factors are being internalized, health threats are no longer due to environmental pollution or defective social conditions. Rather, it is the individual who is unable to cope because he harbors physiological or genetic anomalies that prevent adequate adaptation to unhealthy externalities. As public health is bereft of its preventive functions, adequate health becomes a matter of individual solvency and initiative, thus deepening the gap between the affluent and the majority who lack the means to acquire health insurance, improve their life-styles or schedule regular controls and extensive lab work-ups.