© The Author 2007. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
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The prevention of disease and promotion of health: the need for a new approach
S. Leonard Syme** Professor of Epidemiology and Community Health (Emeritus), School of Public Health, University of California Berkeley, U.S.A.
Correspondence: S. Leonard Syme, Professor of Epidemiology and Community Health (Emeritus), School of Public Health, University of California Berkeley, CA 94720-7360, U.S.A., tel: (510) 642-3712, fax: (510) 642-2857, e-mail: slyme@berkeley.edu
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One of the major goals in the field of health promotion and disease prevention is to identify risk factors for disease so that information about these risk factors can then be shared with people. Our hope is that people will use this information to change their behavior to lower their disease risk. There are three major problems with this model that require our serious attention.
The first problem is that after decades of epidemiologic research, it has proven very difficult to identify disease risk factors. Consider, for example, the case of coronary heart disease. For over 50 years, extensive research has been done all over the world to identify risk factors for this disease. As a result, we now have knowledge about many of them including serum cholesterol, high blood pressure, cigarette smoking, physical inactivity, obesity, diabetes and so on. In spite of this success, however, most of the coronary
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