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The distribution of health and disease in human populations reflects where people live, when in history they live, the air they breathe and the water they drink, what and how much they eat, the energy they expend, the occupations they have, the status they occupy in the social order of their communities, whether they are socially isolated or surrounded by friends, and the quality and the amount of medical care they receive. None of this will be news to the audience, except perhaps the order in which the relevant variables are listed, with medical care listed last. Can that be correct? Think about that question in the following context. Mortality from respiratory tuberculosis, as high as 400 per million in England and Wales in 1840,fell by half by 1880, two years before Koch identified the TB bacillus. By 1940, before there was a y effective medical treatment, tuberculosis mortality had fallen to 10% of its level a century earlier (McKeown,1975). The healthcare system had little to do with these profound changes; they reflected better housing, improved nutrition, less hazardous working conditions and public education. Only in the last 50 years has medical care become increasingly decisive in clinical outcomes when care is responsive to community needs.

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2004-07-02   |   1,191 visitas   |   Evalua este artículo 0 valoraciones

Vol. 26 Núm.6. Noviembre-Diciembre 2003 Pags. 1-7 Salud Ment 2003; 26(6)