Preventive Medicine and Health Promotion: Ideals or Realities? *

On June 14, 1940, a small group of physicians and public health workerst met informally to discuss a subject in which all were interested,-the next steps in preventive medicine and health promotion. No formal report was adopted; but the following paragraphs have been based on stenographic notes of the discussion, condensed or expanded where necessary for clarity. The participants have agreed to the publication of this summary although the author alone is responsible for the form in which the statement appears. For a quarter of a century, leaders in medicine have been eloquent in presidential addresses on the possibilities of "preventive medicine"; and the "health examination" has been hailed on every hand as the cornerstone of the movement-the foundation of a new approach to medical practice. Representatives of the field of public health have joined in the chorus and have suggested that while a passage from alleviative to preventive medicine is a step forward, even the word "preventive" has a somewhat negative connotation. We are told that what we really need is "constructive" medicine or "health promotion." A chair of preventive medicine has been established in one university, linking the departments of clinical medicine and public health. We are all one big happy family, working for health as a positive ideal, rather than for the mere postponement of death. This picture is an alluring one; but how far has the dream been translated into reality? To what extent has the actual practice of the individual doctor in his office and in the home been changed by all our eloquence? Is even "preventive medicine"-let alone, "health promotion"-a catchword-or a reality? Preventive medicine, in the sense of public health-the control of herd epidemics by sanitation and immunization-has indeed great triumphs to its credit. Typhoid fever, infant diarrhea, diphtheria,