McGinnis J M, Hamburg M A
West J Med. 1988 Oct;149(4):468-74.
Advances in medicine offer unprecedented opportunities to improve health. New diagnostic, care, and treatment approaches are having a tremendous impact; yet, the leading causes of morbidity and mortality in the United States are intimately linked to preventable factors such as smoking, improper nutrition, alcohol misuse, lack of exercise, and maladaptive behaviors. Compelling evidence indicates that reducing risk factors yields substantial overall health benefits and saves lives. Prevention efforts can be applied effectively at many points in a disease process, and clinical medicine has a significant role. Nonetheless, a number of barriers may interfere. These include physician education and attitudes; patient education, expectations, and motivations; and aspects of the health care delivery system itself, such as access and reimbursement. The situation has been complicated by the apparent lack of consensus on the appropriate frequency and scope of such activities.
医学进步为改善健康提供了前所未有的机遇。新的诊断、护理和治疗方法正在产生巨大影响；然而，美国发病和死亡的主要原因与吸烟、营养不当、酒精滥用、缺乏运动和适应不良行为等可预防因素密切相关。有力证据表明，降低风险因素可带来显著的整体健康益处并挽救生命。预防措施可在疾病过程的多个阶段有效实施，临床医学发挥着重要作用。尽管如此，仍有一些障碍可能会产生干扰。这些障碍包括医生的教育和态度；患者的教育、期望和动机；以及医疗保健服务系统本身的一些方面，如可及性和报销。由于对此类活动的适当频率和范围显然缺乏共识，情况变得更加复杂。
