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 In the course of human history Preventive Medicine/Public Health interventions have saved more lives than all medical treatments combined. This is often forgotten because no wonder drugs, surgery or miracle cures were involved. Instead, measures such as assuring access to clean food and water, practicing simple lifestyle behavior changes such as hand washing, putting garbage in a bin and getting recommended vaccines on schedule saved countless millions of people from unnecessary suffering and death.Until the early 20th century most people in the US died of preventable infectious diseases. Antibiotics got the credit for controlling these diseases because few people know that death rates from infectious diseases began falling many years before antibiotics became widely available. In fact, infectious diseases were controlled mostly by prevention-oriented doctors from many specialties who realized the importance of cleanliness and encouraged the public and their fellow doctors to change their habits. As the story of hand washing [link to the story of handwashing] illustrates change did not always come easily, but it did come. Now, in the 21st century we are at a crossroads again, the most common causes of death are preventable lifestyle diseases caused by the foods we eat and way that we live. The standard medical treatments available today like the treatments in past centuries do not cure lifestyle diseases and have potentially dangerous side effects. Once again, prevention-oriented practitioners in all medical specialties are urging the public and their colleagues to change lifestyle habits to prevent unnecessary suffering and death.  Currently Preventive Medicine is practiced on three levels, primary, secondary and tertiary. Primary prevention aims to avoid disease occurrence and is most commonly associated with government agencies and public health departments that assure health services such as clean water, sanitation, food safety, and communicable disease control. This has been successful for infectious diseases and public safety but not for lifestyle diseases. Judging by the growing epidemic of lifestyle diseases, current primary prevention efforts that focus on population-based health education/health promotion programs and food industry nutrition guidelines are not sufficient. Despite the enormous scope of the problem the Centers for Disease Control and Prevention (CDC) allocates less than 5% of its annual budget to lifestyle/chronic disease prevention. The fact that most primary prevention programs still refer to lifestyle diseases as "chronic diseases" is a part of the problem. That term discounts lifestyle and reinforces the myth that everyone will get these diseases in time. This myth along with the lack of public health resources to promote and support primary prevention lifestyle behavior changes leads to much unnecessary suffering and death.
Secondary prevention aims to avoid disease progression by screening for the early stages of disease when it can be easily treated and "cured." Mammograms to detect early breast cancer and finger sticks to check for diabetes are examples of secondary prevention. This is the main focus of clinical preventive medicine as it is currently practiced. There are two fundamental problems with screening for lifestyle diseases. First, most people who have standard American lifestyle habits have some stage of at least one standard American lifestyle disease. Second, there are no cures for lifestyle diseases, current medications treat symptoms and risk factors. Surgery removes cancer but not the underlying conditions that allowed the cancer to grow. |
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Consequently, "preventive" screening most often results in detection of some stage of a lifestyle disease and medications for life with the accompanying medication side effects. While screening is very important if you have risk factors for certain diseases, the biggest risk factor for any lifestyle disease is an unhealthy lifestyle that includes a diet of mostly animal products and lack of exercise. There is high quality scientific evidence to prove that diseases such as prostate cancer, breast cancer, type 2 diabetes, and the clogged arteries that lead to heart attacks and strokes can be reversed by a plant-based diet. Yet few people are ever told at any stage of the screening and treatment process that comprehensive lifestyle changes that include a plant based diet could completely reverse their disease. Instead of being "preventive", screening is often a missed opportunity to provide the evidence-based health information that would lead to true lifestyle behavior changes and prevent unnecessary suffering and death. 
Tertiary prevention aims to avoid disability and untimely death from established disease by restoring function and reducing complications and disease recurrence. Cardiac rehabilitation after a heart attack and bypass surgery is one of the most common examples of tertiary prevention for a lifestyle disease. Thankfully this is changing but most current cardiac rehabilitation programs focus on exercise which is extremely beneficial but not for unclogging blocked coronary arteries. They also provide outdated nutrition advice, despite well documented scientific evidence that a mainly plant based diet will reverse coronary artery blockage, few program offer this advice exclusively or have the expertise to support patients who want to make this lifestyle change. Hopefully, now that high profile public personalities such as former President Bill Clinton have adopted plant-based eating to prevent recurrence of heart problems the public will become interested and demand programs that actually unclog arteries and prevent unnecessary suffering and death.
