2 PATIENCE H. WHITE AND ROWLAND W. CHANG
coordinated approach with increased need for morearthritis specialists, increased need for training of primary care providers in arthritis management, andincreased availability of public health interventions toimprove quality of life through lifestyle changes anddisease self-management.
THE MEDICAL MODELCOMPARED WITH THE PUBLICHEALTH MODEL
There are several differences between medicine andpublic health, but perhaps the most important differ-ence is that of perspective. Medicine focuses on the
diagnosis and treatment
, whereas publichealth focuses on the
assessment and the reduction of health burden in the population
. The diagnostic toolsof the physician includes history, physical examination,and a vast array of diagnostic tests including bloodtests, imaging, and tissue sampling, all performed onthe individual patient. Medical treatment includespharmaceuticals, surgery, and rehabilitation. Theassessment tools of the public health professionalinclude surveys and disease registries for deﬁned popu-lations (local, state, and/or national). Public healthintervention includes community health educationand programs and advocacy for public policy reform.Medical research programs emphasize basic science,drilling down to individual abnormalities at themolecular and genomic level, whereas public healthresearch programs emphasize epidemiology and thesocial sciences, searching out risk factors that pertainto a large proportion of the population. While medicalscience has undeniably improved the individual treat-ment of some forms of arthritis (e.g., rheumatoidarthritis), still much more needs to be done to dealwith the coming increases in arthritis prevalence andarthritis-related disability associated with the aging of the US population. This is perhaps the most importantreason to embrace an arthritis public health initiative:to have a greater impact on the health of thepopulation.
PUBLIC HEALTH’S EMPHASIS ONPREVENTION AND HOW ITRELATES TO ARTHRITIS
Traditionally, public health has been concernedwith the prevention of disease and the preventionof disease consequences (e.g., death and disability).Three types of prevention have been described:primary, secondary, and tertiary. Primary preventionis the prevention of the disease itself. In the infectiousdisease realm, this is made possible by the identiﬁca-tion of the etiologic microorganism and the develop-ment of a vaccine that will protect the host fromdeveloping the infection even when the host is exposedto the microorganism. Primary prevention of a chronicdisease requires the identiﬁcation of an etiologic factorassociated with the disease and the successful inter-vention (lifestyle change and/or pharmacologic treat-ment) on the risk factor. For example, the reductionof weight by dietary and physical activity interventionhas been successful in the primary prevention of dia-betes, and the pharmacologic treatment of hyperten-sion has proven effective in the prevention of coronaryartery disease. An example of a primary arthritisprevention trial showed that a vaccine for the spiro-chete associated with Lyme disease reduced the riskfor this disease in endemic areas (6). While severaletiologic factors associated with knee osteoarthritis(most notably obesity) have been identiﬁed, no trialshave been performed to inform public health practiceregarding the primary prevention of this condition,
ESTIMATED US POPULATION AND PROJECTED PREVALENCE OF DOCTOR-DIAGNOSED ARTHRITIS ANDACTIVITY LIMITATION FOR ADULTS AGES 18 AND OLDER IN THE UNITED STATES.
PROJECTED PREVALENCE OF PROJECTED PREVALENCE OF ARTHRITIS-ESTIMATED US POPULATION DOCTOR-DIAGNOSED ARTHRITIS ATTRIBUTABLE ACTIVITY LIMITATIONSYEAR IN THOUSANDS IN THOUSANDS IN THOUSANDS
2005 216,096 47,838 17,6102015 238,154 55,725 20,6012030 267,856 66,969 25,043
: Hootman JM, Helmick CG, Arthritis Rheum 2006;54:226–229, by permission of