Now, let's see - where were we? It's been a stressful summer, and fall could be a portent for a fall I need to anticipate. But the question still remains - how do I incorporate primary prevention into the daily regimen of a practicing speech - language pathologist? Who will buy?
To fend off any rejection of primary prevention by the CSD (communication sciences and disorders) professions, the answer to "Why do it?", is - our professions mandate it. Our consumers and their advocates are healthier for it. The healthcare industry is inexorably being drawn to carry prevention on its back. We want less and less occurrences of disability and death. Our moral and ethical selves should embrace prevention for their professional lives.
The goal of primary prevention activities is "to prevent a disease from ever occurring" (Kisling and Das, 2023). Most of us might think that preventing disease is the physician's job, but we all have had personal experiences - that we, or those we know well, once arrived at a doctor's office or emergency room very sick. Your doctor may often be ignorant of risk factors for disease that you're carrying, until you show full - blown symptoms of the disease.
We know that both presymptomatic and predictive testing for a growing number of medical conditions, through laboratory and radiological means, are evolving to become more everyday tools in the medical clinician's toolbox (LifeLineScreening, n.d.; Dagonnier, Donnan, Davis et al., 2021; Lawrence, 2004). Though major medical centers with precision medicine emerging in their product lines, declare their intent is to make healthcare "predictive, preventative, personalized and participatory" (Flores, Glusman, Brogaard, et al., 2013), the state of the science does not yet empower all the persons served, to better their health.
Large medical research centers have the cachet that will attract many health consumers to share their DNA with laboratories. Their growth from the time of World War II to the present, has brought together sterling resources for medical education, clinical and basic research, patient care and health policy advocacy (Coleman and Dang, 2023). But if you want to make big consequential changes in how people can stay healthy throughout their lives, is it easier to turn a luxury cruise ship, or a Mini Cooper?
Not only must a prevention intervention be effective, or do what is intended; be safe to the consumer and her circles of support; but also, efficient for delivering the best possible outcome at the best possible cost. A counterpoint to "precision public health" (Khoury, 2018; Thaler, 2019), which employs big data sets, genomic sequencing and precision laboratory interventions, might be a human scale involvement in risk reduction, by members of a population. This type of intervention would attempt to connect the cultural influences upon a population's health status, with the outcomes for intervention they desire. This intervention might include, in the case of primary prevention for cardiovascular disease:
* baseline and serial assessment of individuals' cardiovascular risk
* analysis of the cultures in which each participant exists
* education via printed material developed from the cultural interviews, surveys and observations
* education via publishing monthly cardiovascular (CV) risk reduction activities in a community, upon a web-based/hard copy calendar
* education via participation in dedicated lectures on the major domains for CV risk
* assessment of individuals' active involvement in learning management strategies for CV risk
* periodic assessment of the satisfaction of population members with the prevention intervention
* replication of the prevention program within different cultural communities
This intervention does not mandate for participants a sole method for reaching their CV risk goals. It allows the individual to develop insight for what she/he might control to gain/retain a healthy CV system, and act as she finds it possible within her means and her culture. Studies done over the past decade (Winham, 2009; Stuart-Shor, Berra, Kamau and Kumanyika, 2012; AHA, 2023) may echo the sentiment of a contemporary comedy movie: "It's just culture; that's all" (Chadha and Nayar, 2003). There's the future - perhaps! The future will tell whether primary prevention based on a culturally - sensitive model will attract the energy of more speech - language pathologists. Will you buy?
REFERENCES
1. Kisling, Lisa A., and Das, Joe M. Prevention Strategies, In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.. Retrieved 11/7/23 from https://pubmed.ncbi.nlm.nih.gov/30725907/
2. LifeLine Screening: The Power of Prevention. n.d. Retrieved 11/7/23 from https://www.lifelinescreening.com/ppc-149?sourcecd=WGBS101&utm_source=WGBS101&utm_medium=cpc&utm_campaign=11845162922&utm_term=lifeline%20screening&gad_source=1&gclid=CjwKCAiA3aeqBhBzEiwAxFiOBr37IradPa2SDZgpn_3tUISRICNkHnxoW1Hm_xlDACr-3bkaSiiyhxoC8DAQAvD_BwE&gclsrc=aw.ds
3. Dagonnier, Marie, Donnier, Geoffrey A., Davis, Stephen M., et al. Acute Stroke Biomarkers: Are We There Yet? Frontiers in Neurology, 12, 2021. Retrieved 11/7/23 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902038/
4. Lawrence, Bill (executive producer). "My Fault", Season 3, Episode 20 of Scrubs. Originally broadcast on 4/22/2004. Retrieved 11/7/23 from https://www.youtube.com/watch?v=R9hEa8LKG4c
5. Flores, Mauricio, Glusman, Gustavo, Brogaard, Kristin, et al., P4 Medicine: How Systems Medicine Will Transform the Healthcare Sector and Society. Personalized Medicine, 10(6), 2013, 565 - 76. Retrieved 11/7/23 from https://pubmed.ncbi.nlm.nih.gov/25342952/
6. Coleman, Kara, and Dang, Donna. 37 Scientists Pionerring the Future of Biomedical Research. Pew Trusts, June 13, 2023. Retrieved 11/7/2023 from https://www.pewtrusts.org/en/research-and-analysis/articles/2023/06/13/37-scientists-pioneering-the-future-of-biomedical-research
7. Khoury, Muin J , Bowen, M. Scott, Clyne, Mindy, et al., From Public Health Genomics to Precision Public Health: A 20 - Year Journey. Genetic Medicine, 20 (6), June 2018, 574 - 582. Retrieved 11/7/23 from https://pubmed.ncbi.nlm.nih.gov/29240076/
8. Thaler, David S., Head, Michael G., and Horsley, Andrew. Precision Public Health to Inhibit the Contagion of Disease and Move Toward a Future in Which Microbes Spread Health. BMC Infectious Diseases, 19(1), February 6, 2019. Retrieved 11/8/23 from https://pubmed.ncbi.nlm.nih.gov/30727964/
9. Winham, Donna M. Culturally Tailored Foods and CVD Prevention. American Journal of Lifestyle Medicine, 3(1), 2009, 64S - 68S. Retrieved 11/8/23 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782861/
10. Stuart - Short, Eileen M., Berra, Kathy A., Kamau, Mercy W. and Kumanyika, Shiriki K. Behavioral Strategies for Cardiovascular Risk Reduction in Diverse and Underserved Racial/Ethnic Groups. Circulation, 125, January 3, 2012, 171 - 184. Retrieved 11/8/23 from https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.110.968495
11. American Heart Association. Culture, Diet, Economic Factors and More Affect CVD Risk Among Asian Americans. Newsroom, May 8, 2023. Retrieved 11/8/23 from https://newsroom.heart.org/news/culture-diet-economic-factors-and-more-affect-cvd-risk-among-asian-americans
12. Chadha, Gurinder, and Nayar, Deepak (Producers). Bend It Like Beckham. Original release March 12, 2003. Retrieved 11/8/23 from https://www.rottentomatoes.com/m/bend_it_like_beckham
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