walson on medicine and science population .pptx

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1. POPULATION INCREASE IN RELATION TO PATTERNS OF DISEASE During the past 50 years and especially during the past 20, there has been little change in the United States crude death rate, yet a doubling of the United States population has occurred . the principal way this doubling of the population could be attained was by minimizing the wastage"of early death and by ensuring that each person born into this society had the maximal chance to survive through the child bearing period and on into middle,” or old, age.

2. two arms of today’s dual system attained this technologic “ decisiveness ” in an historic sequence rather than in parallel, their respective influences are now operative simultaneously on each of us in our twin roles of being both an individual and a member of a group . With this dual system, the disease pattern or “level of health” in the industrialized countries has been modified to one that usually permits a long period of personal effectiveness and productivity. examine the degree of fitness of our two systems—the clinical physician system and the public or nonclinical physician system—to the substrate represented by the disease patterns in these economically underdeveloped or ““ overly traditional ” societies.

3. The total disease substrate represented by the core pattern thus consists of two quite distinct halves—the disease events of the very early years, principally the first year , and the diseases of middle age and thereafter. ‘ With respect to the infant part of the core pattern, our relative lack of a decisive technology to put in the hands of the clinical physician faced with the particular conditions of the overly traditional societies has been previously discussed. CULTURE AND THE PATTERNS OF DISEASE – How do the domicillary sanitary “barriers” influence the situation ?

4. First it must be also present in adults, such as tubercilosis ; others die from culturally linked diseases, such as tetanus of the newborn ; and some are killed by vector-borne disease in those localities where such are present. For those still physiologically unstable, notably the infants, the clinical physician system has little to offer in the way of specific drugs or vaccines in the absence of these structural and functional sanitary barriers of a modern home. THE VICIOUS CYCLE—HIGH FERTILITY AND HIGH INFANT MORTALITY

5. The continued high infant and preschool mortality prevents the formation of one of the major preconditions necessary for the lowering of human fertility. In order to effect a widespread reduction in human fertility, therefore, it is first necessary to create a set of conditions in which the consequences of the high fertility come to seem disadvantageous to individual couples in almost infinite numbers . in rural areas, where the majority of the people in the economically underdeveloped societies still live, high fertility can appear highly advantageous to the individual couple . there is considerable evidence that many of the women would be happier with fewer pregnancies, but their views are not always taken into account .

6. DEMOGRAPHIC CONSIDERATIONS- as long as there continues to be high infant and early child hood mortality, it is very hard to make sustained high fertility seem disadvantageous. The situation for high infertility for middle class and uneducated rural popualtion is different. For rural the successful preservation of their own family, a high fertility seems a good thing .‘ This situation might be modified significantly by a major development in contraception technalogy , for example, a “pill” that need only be taken once per lunar — month, or a chemical that could exert long enduring action following a single injection

7. Where the preconditions have been established, programs based largely on contraceptive technology have met with a fairly good reception. Without the preconditions, however , programs largely based on contraceptive technology have had very little success. to have the first steps in slowing population growth take the form of attempts to lower mortality still further .

8. EARLY DISEASE AND HUMAN QUALITY w hereas this need to create the preconditions for an effective program of family planning represents the major reason why a biomedical component is essential in a national program of socioeconomic development, there is a second reason, almost as compelling , that is likewise related to this high infant and early childhood morbidity and mortality.

9. THE APPLICATION OF MEDICAL SCIENCE FOR THEINITIATION OF POPULATION CONTROL For these two reasons (preconditions for family limitation, assurance of maximal educability ), therefore, it is essential that the disease pattern of the overly traditional societies be sufficiently modified so that programs of socioeconomic development may proceed . The first and almost certainly the one of outstanding importance is to use our scientific knowledge to improve the total food supply for infants and young children, notably the supply of high quality protein.

10. A second approach through the nonclinical physician system is by the scientific manipulation of the extradomicillary , i.e., the “outdoors” environment. For certain diseases , notably malaria, this approach can be highly effective, but two qualifications have to be made. The third approach possible via the nonclinical physician system is a pluralistic program aimed principally at the core disease pattern that plays such a'large role in the high youthful mortality . Of these three possible approaches via the nonclinical or public physician system ( protein , extradomicillary environmental intervention, and alteration of the events within the home ) only the first has at present received adequate attention in terms of biomedical science and technology.