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CMA POLICY

THE ROLE OF PHYSICIANS IN PREVENTION


AND HEALTH PROMOTION
(UPDATE 2001)

Physicians play an essential role in promoting health and preventing disease in Canada.
This statement outlines the CMA's policy on the role of physicians in prevention and health
promotion and provides recommendations for strengthening this role in the future.

Health care professionals, including disease or disorder will affect an individual,


physicians, play an essential role in interrupt or slow the progress of the disorder,
promoting health and preventing disease or reduce disability." Goulds Medical
among all Canadians. A significant proportion Dictionary defines preventive medicine as
of death, illness and injury in Canada is any activity that seeks to prevent disease,
preventable. These preventable health prolong life, and promote physical and mental
problems place a substantial burden of health and efficiency.
suffering on individuals, families and
communities as well as a heavy burden on The CMA views prevention and health
society because they draw on scarce health promotion as a responsibility to be shared
care resources. among all health care providers, rather than
the sole responsibility of any one group. The
The World Health Organization defines health spectrum of health promotion and disease
promotion as "the process of enabling people prevention programs contains the following
to increase control over and improve their five levels: (1) health enhancement, (2) risk
health." Health promotion activities might avoidance, (3) risk reduction, (4) early
influence either a persons individual identification and (5) complication reduction.
behaviour (e.g. smoking, sedentary lifestyle)
or the broader social determinants of his or The role of physicians in this continuum of
her health (e.g. income and education level, patient care is a strong one, with the potential
physical environment). Prevention has been for further enhancement.
defined by Health Canada as "activities and
approaches which reduce the likelihood that a

2001 Canadian Medical Association. You may, for your non-commercial use, reproduce, in whole or in part and in any form or manner,
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1867 Alta Vista Drive, Ottawa, ON K1G 3Y6; tel 888 855-2555 or 613 731-8610 x2307; fax 613 236-8864.
All policies of the CMA are available electronically through CMA Online (www.cma.ca).
physicians to identify those patients at high
Health-promotion and prevention activities risk of illness or disease and to use case-
Physicians deliver a wide range of services finding techniques. Papanicolaou smears to
within the spectrum of preventive patient detect cancer of the cervix and mammograms
care: to detect breast cancer are two types of tests
being used in early detection.
Health enhancement: As part of daily
practice, physicians routinely offer Complication reduction: Physicians can
counselling and information to encourage prescribe therapy to prevent complications in
healthy lifestyles among all patients. These patients with diagnosed conditions or
activities include appropriate age-related diseases. For example, the use of warfarin in
discussions with patients about nutrition, the presence of atrial fibrillation reduces the
physical activity and adjustment to life stages. incidence of stroke. Similarly, lipid-lowering
In providing these services, physicians take agents prescribed for certain patients who
into account the emotional, social, spiritual have suffered a myocardial infarction reduce
and environmental conditions in which their the incidence of subsequent coronary events.
patients conduct their lives. With the increase in public awareness and
interest in preventive medicine, physicians
Risk avoidance: Physicians ensure that often spend time with their patients discussing
people at low risk of disease or injury remain the pros and cons of tests such as
at low risk. In most jurisdictions, physicians mammographic screening of women and the
provide childhood immunizations and, for prostate-specific antigen (PSA) screening test
adults at higher risk, influenza, hepatitis B or for men.
pneumococcal vaccines. Physicians routinely
encourage breast-feeding, moderate exercise Medical organizations are also involved in
and the use of bicycle helmets, to name a few prevention and health-promotion activities
examples. such as organizing public education
campaigns, lobbying for legislation that
Risk reduction: Physicians target individuals promotes health, such as laws to control
or segments of the population at moderate or pollution and tobacco products, and
high risk of disease or injury in order to disseminating clinical practice guidelines to
reduce their risk. They ask their patients about enhance standards of preventive care.
high-risk activities such as smoking, alcohol
abuse or unsafe sex. Physicians have the Recommendations
education and tools to counsel these patients 1) Physicians should continue to
to change their behaviour in order to reduce incorporate all levels of health
their risk of disease. To reduce the risk of promotion and disease prevention into
heart disease, physicians screen and treat their practices, emphasizing activities
patients for risk factors such as high blood for which there is sufficient scientific
pressure and elevated serum cholesterol evidence to justify their practice (for
levels. example, an A or B recommendation
by the Canadian Task Force on
Early identification: Physicians screen people Preventive Health Care).
to detect diseases at an asymptomatic stage, 2) Education in prevention and health
when intervention can improve the outcome. promotion (including how to deliver
Access to detailed patient information allows these services effectively in an office
2
setting) should be given high priority 7) Simple, easy-to-understand patient
in undergraduate medical programs, in guidelines for prevention and health
residency training and in continuing promotion should be developed and
medical education. made available to the public.
3) Physicians should be encouraged to Physicians should continue to
work with other health care develop, improve and promote patient-
professionals in the office setting and counselling programs and office-
the community to enhance delivery of management systems that encourage
the entire spectrum of these services. effective delivery of preventive care
4) Remuneration systems should support and health promotion.
a multidisciplinary approach to the 8) Governments should give high priority
delivery of these services when this to public policies that take account of
approach is appropriate. Physician- the broad range of determinants of
payment models should facilitate the health, and proposed legislation
provision of these services by should be routinely reviewed for any
individual physicians. impact on the health of individuals
5) Each patient should have access to, and the community. CMA, in
and be encouraged to select, a collaboration with other health
personal family physician who can professions and governments, will
provide continuous care, including continue to explore means to ensure
preventive services and health- that public policies are developed with
promotion counselling. Family due attention paid to their potential
physicians should continue to develop health consequences.
professional relationships with their
patients that encourage the long-term
promotion
and maintenance of good health.
6) Clear, simple and current guidelines
for prevention and health promotion
services should be widely distributed
to physicians. CMA values the work
of the Canadian Task Force on
Preventive Health Care in its regular
review of preventive guidelines.