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By C. David Jenkins

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Additional resources for Building Better Health. A Handbook of Behavioral Change (Scientific and Technical Publication)

Example text

Of course, numerous non-fatal cases also were prevented. Similarly, today thousands of PRINCIPLES OF COMMUNITY HEALTH INTERVENTION 27 51331_p029_048_r1 4/7/03 3:11 PM Page 28 persons are wearing their automobile seatbelts for thousands of days each, for just one life to be saved. These are examples of preventive measures—risk factor reductions—that bring large benefits to the population as a whole, but little or no benefit to most participating persons. Such high ratios of participants to persons benefiting must always be the case in situations where we know there will be many destructive events in a population but do not know who might become the victim.

Vaccination coverage rates need only be between 70% and 90% (depending on the pathogen) for “herd immunity” to be adequate to prevent epidemics, but that will not eliminate scattered individual cases. And cigarette smoking needs only to continue declining steadily. Once a society starts to perceive smoking as PRINCIPLES OF COMMUNITY HEALTH INTERVENTION 21 51331_p029_048_r1 4/7/03 3:11 PM Page 22 “out of style,” dirty, and harmful to the smoker and to others, then the momentum of social change will make the ashtray as obsolete as the cuspidor.

The general public remains unbothered. There is, however, a convincing argument to the contrary for most widespread maladies. By targeting the intervention program at the whole community and getting the most community members to lower their risk factor by a small percentage, a much greater reduction in new cases and mortality will be achieved. This is the “population strategy” put forth by the late Professor Geoffrey Rose, Emeritus, from the London School of Hygiene (Rose, 1992) and others. In his book, Professor Rose used epidemiologic data to put forward the following points: • Most biologic, psychological, and social parameters associated with rates of disease are distributed in a roughly normal, or bell shaped, curve in the population.

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