According to legend, Aesculapius bore two daughters, Panacea and Hygeia, who gave rise to dynasties of healers and hygienists. The division remains today, in clinical training and in practice; and, because of the imperative nature of medical care and the subtlety of health care, the former has tended to dominate. Preventive medicine has as its primary objective the maintenance and promotion of health. It accomplishes this by controlling or manipulating environmental factors that affect health and disease. For example, in California presently there is serious suffering and substantial economic loss because of the failure to introduce controlled fluoridation of public water supplies. Additionally, preventive medicine applies preventive measures against disease by such actions as immunization and specific nutritional measures. Third, it attempts to motivate people to adopt healthful lifestyles through education.

For the most part, curative medicine has as its primary objective the removal of disease from the patient. It provides diagnostic techniques to identify the presence and nature of the disease process. While these may be applied on a mass basis, they are usually applied after the patient appears with a complaint. Second, it applies treatment to the sick patient. In every case, this is, or should be, individualized according to the particular need of each patient. Third, it utilizes rehabilitation methodologies to return the treated patient to the best possible level of functioning.

While it is true that both preventive medicine and curative medicine require cadres of similarly trained personnel such as planners, administrators, and educators, the underlying delivery systems depend on quite distinctive professional personnel. The requirements for curative medicine call for clinically trained individuals who deal with patients on a one-to-one basis and whose training is based primarily on an understanding of the biological, pathological, and psychological processes that determine an individual’s health and disease status. Preventive medicine, on the other hand, calls for a very broad spectrum of professional personnel, few of whom require clinical expertise.

The economic differences between preventive medicine and curative medicine have been extensively discussed, perhaps most convincingly by Winslow in the monograph The Cost of Sickness and the Price of Health. Sickness is almost always a negative, nonproductive and harmful state. All resources expended to deal with sickness are therefore fundamentally economically unproductive. Health, on the other hand, has a very high value in our culture. To the extent that healthy members of the population are replaced by sick members, the economy is doubly burdened. Nevertheless, the per capita cost of preventive measures for specific diseases is generally far lower than the per capita cost of curative medicine applied to treatment of the same disease.

There is an imperative need to provide care for the sick person within a single medical care system, but there is no overriding reason why a linkage is necessary between the two components of a health care system, prevention and treatment. A national health and medical care program composed of semiautonomous systems for personal health care and medical care would have the advantage of clarifying objectives and strategies and of permitting a more equitable division of resources between prevention and cure.

Which of the following is NOT a measure of preventive medicine?