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New Health Section Is a Hit . . . Mostly

September 15, 1997

Kudos to you and your staff for creating the new Health section! As a long-standing reader of the L.A. Times, this is a welcome addition. Consumer interest in health-related issues has never been higher. And your focus on prevention is most welcome. I wish you every success.

Now for a minor--but important--critique of your lead article ("Ahead of the Game," Sept. 8) reported by Thomas Maugh. Given the emphasis you've placed on prevention, I am surprised to see that Maugh uses the same, dare I say "tired," taxonomy that has always been used when an attempt is made to present the major "causes" of death: an array of terms more relevant to pathophysiology than to actual cause-effect relationships.

In their classic 1993 JAMA article "Actual Causes of Death in the United States," Michael McGinnis (former deputy assistant secretary for Health) and William Foege (former director of the Centers for Disease Control and Prevention) looked at this issue in a more operationally useful way. Their review of the 2,148,000 deaths in the U.S. in 1990 took the perspective that there are "inborn [largely genetic] factors" and "external factors" that create these pathophysiologic processes. It gets complicated, but the bottom line they found for identifiable causes of death was as follows:

1. Tobacco: 400,000 deaths

2. Diet / activity patterns (sedentary lifestyle): 300,000 deaths

3. Alcohol: 100,000 deaths

4. Microbial agents: 90,000

5. Toxic agents: 60,000

6. Firearms: 35,000

7. Sexual behavior: 30,000

8. Motor vehicles: 25,000

9. Illicit use of drugs: 20,000

As McGinnis and Foege point out, this reconceptualization of the real contributors to death in the U.S. is important from both a public health and personal health perspective.

If these things are killing people, do we spend enough money to address them?


Director, Student Health

Services, and adjunct professor

of public health

San Diego State University


Thomas Maugh's road map to a healthier life serves as a powerful mandate for us to take a more active role in preventing disease and accidents in our lifetimes.

Our society has typically placed inordinately great value on high-tech and high-cost medical interventions that intend to thwart illnesses in their advanced stages, and less value on the advocacy of long-term preventive measures. For this and other reasons, we are more willing to write checks in the doctor's office than we are to make changes in our lifestyles that may, in the long run, preclude many of these visits. All too often do we expect clinical intervention to miraculously surmount the effects of years of neglect and abuse on our part.

How many readers actually follow the USDA's simple and relatively pleasant guideline of eating five servings of fruits and vegetables per day for better health? Change of this nature is best begun with small, practical steps.

"Knowledge Is Power and Can Help Pave the Road to Prevention," says the sub-headline. But without praxis, without dedicated application of this knowledge, the road remains littered with hazards.



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