Intended for healthcare professionals

Education And Debate

silent prevention

BMJ 2004; 329 doi: (Published 01 July 2004) Cite this as: BMJ 2004;329:43
  1. Nicholas J Wald, director (
  1. Wolfson Institute of Preventive Medicine, Barts and the London, Queen Mary's School of Medicine and Dentistry, London EC1M 6BQ

    Oakley and Johnston correctly criticise Britain's failure to fortify flour with folic acid. But the interventionist principle in nutrition and other areas of public health goes beyond folate. Contrary to current perception, the key to effective public health is not individual choice but collective action linked to public trust in its value.

    Most of the main determinants of health vary little among people in a community. The scope for individuals to choose healthy and safe foods, drinks, transport, or buildings is limited; the similarities in exposure are greater than the potential differences. To differ significantly from the collective norm we would have …

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