Who needs health care?

Editor—Before decrying preventive medicine in her article “Who needs health care—the well or the sick?” Heath should have defined the term.¹ The best of preventive medicine has saved more lives and reduced more suffering at far less cost than all medical interventions, whether in the shape of immunisation, improved sanitation, or better diet. Prevention is about population interventions that are usually low cost and lead to reduced disability and death.

I believe that Heath is really talking about expensive interventions for chronic disease, usually the result of excess use of unneeded drugs such as alcohol and tobacco, or lack of exercise, among others. When these behaviours catch up with people they consult a doctor, having read of medical miracles in the newspapers and believing that medical intervention will regain a state of health.

These activities on behalf of older people in developed countries (which I think is what Heath is talking about) are not prevention (primary or secondary). If this article helps people think twice about the use of the terms “health care” and “medical care” and learn to distinguish between them it will have been useful. National and individual resources can be put to better use than the medical fad of the minute.

The policy and philosophical issues of prevention compared with medical care are important. This article confused the issues. Preventive medicine is a well defined discipline. The terms prevention and health care are often used incorrectly by medical professionals and lay people. I encourage the editors to devote an issue to the advances in prevention in developed and developing countries over the past 50 years to provide readers with a clearer understanding of prevention compared with medical care.