Primary prevention: a new look at basic concepts.

Personal health and well-being are gaining priority on the American agenda. A renewed interest in health promotion has been facilitated by the need to contain health care costs, realization of the limits of medicine in preventing illness, and a deeply rooted societal ethic of personal responsibility for individual health. Although the health status of Americans has changed significantly for the better during this century, further improvements are necessary, especially among high risk subgroups within the population who have not been effectively reached by traditional health promotion strategies. Past efforts, aimed at individuals modifying their risk factors, have neglected to address environmental factors that contribute to disease risk. This points to the need for an integrated approach where problems are addressed as properties of the systems in which individuals behave. This paper reviews selected health trends in the United States, discusses limitations of the current approach to health promotion, presents a comprehensive definition of prevention, and provides principles for planning that may facilitate improved health status in this country.