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Live well, live long: Medicine turns focus to well-being

A leading public health expert says a third era of health care has begun that emphasizes on improving quality of life rather than just increasing its length.

By Victoria Stagg Elliott, amednews staff. Aug. 21, 2006.

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Wayne Reynolds, DO, a family physician in Newport News, Va., has never seen a case of measles and can't remember the last time he diagnosed chicken pox. Both infectious diseases were leading causes of death a hundred years ago.

Of course, acute illnesses are still a frequent focus of patient visits in his practice. But he also spends a great deal of time delivering preventive health care. And he increasingly finds himself treating conditions affecting his patients' quality of life.

"I'm seeing people take a more proactive role in their health," said Dr. Reynolds. "And I do probably see more patients in 2006 for [erectile dysfunction], incontinence and menopause. It's quality of life."

This pattern represents the practice of medicine in the beginning of the third era, or revolution, of health, said Lester Breslow, MD, MPH, ScD, professor emeritus of health services and dean emeritus of the School of Public Health at the University of California, Los Angeles,

The first era, which ran from the beginning of medicine to approximately the middle of the 20th century, focused on battling infectious diseases, which were the leading health threats.

In the 1950s, after many infectious diseases were wrestled into control and people started to live longer, the focus slowly shifted to the chronic diseases. Dr. Breslow, a former director of the California Dept. of Health Services, was one of the first public health officials to work on chronic disease as a serious public health issue.