Measuring the Effectiveness of Prevention

As a society we cannot-and should not-rush to provide every service that offers a potential of disease prevention. Deliberate choices must be based upon careful examination of causality, efficacy, and cost. Such evaluation becomes complex when not only is a given program under consideration for results, but also is compared with similar or competing programs. The data on hand focus attention on possible gains in secondary prevention through changing “life styles,” but larger and more pervasive socioeconomic changes may be preconditions. The most difficult and consequential questions relate to tests of efficacy. Yet the most definitive research measures-randomized clinical trials-may be impossible to apply because of missed opportunities or lack of social controls. Even when “hard” findings on efficacy are available, it is a rocky course to effective implementation of preventive programs. Success will be judged not so much on how we measure prevention, but rather on what we measure. Life-saving and health-saving are not the same, and effectiveness in one area may be counterproductive in the other. But we cannot be immobilized by the imperfection of data; enough is known to aim our efforts at improving long-term research opportunities and short-term prevention.

Author(s): Judith R. Lave; Lester B. Lave; Sam Shapiro; Myron E. Wegman

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Volume 55, Issue 2 (pages 272–314)
Published in 1977