Today, the phrase "disease prevention and health promotion" is commonly
encountered. The idea of disease prevention alone is quite clear:
"Primary prevention means averting the occurrence of
disease . . . [and] . . . secondary prevention means
halting the progression of a disease from its early unrecognized stage
to a more severe one."1
During this century, disease prevention has changed largely from
focusing on reducing environmental exposures over which the individual
had little personal control, such as providing potable water, to
emphasizing behaviors such as avoiding use of tobacco, fatty foods, and
a sedentary lifestyle. Although individuals have a choice in these
matters, as early as 1952 the President's Commission on Health Needs
of the Nation noted that such individual responsibility for health can
be fully effective only if society ensures access to necessary
education and professional services.2 More recent reviews
also have cited the need for social support for individual health
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