Citation

Eisenberg L. J. R. Soc. Med. 1984; 77(4): 268-280.

Copyright

(Copyright © 1984, Royal Society of Medicine)

DOI

unavailable

PMID

6425497

PMCID

PMC1439745

Abstract

This article examines the value context in which health policy is decided and reviews the empirical evidence in support of present and future initiatives in preventie psychiatry. Health ministries today enthusiastically embrace the rhetoric of prevention because of the relentless growth of medical care costs. US health expenditures in 1981 for example accounted for 9.8% of the gross national product, up from 8.9% 2 years previously. A comparison of health gains from vaccination against poliomyelitus with health gains from vaccination against influenza virus illustrates that the dollar amount expended per year of life saved may vary greatly. Vaccination of persons against influenza and pneumonia would necessitate increasing the very health expenditures that governments are trying to reduce. Fundamental problems of social justice exist in the asymmetry between those who pay and those who benefit from preventive health measures, and in the scales on which costs and benefits are assessed. Moreover, prevention of premature death results in a larger population in the older age groups which consume proportionately more health resources. Such consideratons make obvious the danger of trying to justify prevention on purely economic grounds. Medical knowledge provides a technological base for the analysis of health policy options, but the political process, reflecting the power and the values of the various constituencies in society, is what determines which choices are made. Present knowledge of prevention of psychiatric disorders in children must be considered against the context in which policy decisions are made. Prenatal preventive measures migh address birth weight, maternal smoking and alcohol intake, and rubella, and the conditions diagnosed by amnioscentesis. Neonatal screening could be used to identify phenylketonuria and congenital hypothyroidism. Measures to prevent accidents and poisonings could minimize brain trauma. Vaccination has become the paradigm for prevention, an inexpensive measure applied once or a few times to yield permanent immunity, but the model does not apply to the prevention of psychosocial disorders: there is no shortterm psychiatric intervention that confers immunity to later challenge. Psychosocial measures proposed for the reduction of psychiatric morbidity and mortality in childhood and adolescence include family planning, preschool intervention programs, shortterm psychotherapy, and suicide prevention.

Language: en