Feasibility of opportunistic disease prevention: Personal and public health are at stake

EDITOR–The article by Getz et al is particularly relevant in New Zealand, where doctors are being exhorted without respite to consider population health targets, particularly those with countable outcomes, and to identify all biomedical risks in their general practice populations.1 Some “lifestyle” issues are also now acceptable to ask about–including smoking, alcohol consumption, and gambling habits. They may be of no clinical significance for some people, but the line between personal and public benefit is sometimes illusory.

Recently New Zealand's Ministry of Health recommended screening for partner abuse in acknowledgment of the considerable health consequences of relationships that are characterised by behavioural patterns that leave partners fearful, degraded, and dispirited, not to mention physically damaged and, occasionally, dead. A fraction of the money spent treating outcomes placed in the “screening” basket will reap rewards in future for individual people and their children.

Paying attention to the “relational” aspects of the patients in front of us is an intensely personal part of health care–yet part of population screening–perhaps one of the pivots on which public and private health hinge. Ensuring these issues are sensitively covered requires training and a certain amount of courage. However, a growing number of anecdotal outcomes from practitioners involved in smoking, gambling addiction, partner abuse, and obesity issues gives hope that studies from all these areas will be completed to show something “countable” for publication–perhaps reduced antihypertensive and antidepressant requirements, gastrointestinal symptoms, and suicide rates. These are population statistics, personal in their effects.

Fitting relevant “preventive” questions to the patient in front of us at the right moment, is the trick.