Stanza 1 preamble and brief history on medicine
Medicine the act and art of healing is as old as time itself. From time immemorial mankind has had to cope with a natural order that is full of hazards and a plethora of risks that threaten life and limb. These range from acts of God such as floods, famine, earthquakes etc. to man-made afflictions: accidents, armed conflicts, sanitation crisis related plagues and pestilence.
From these early times he contended with his health challenges using the rudimentary rituals of his superstitions and the passions of his religion. Slowly he would evolve into more expert use of the available natural resources for disease control, using herbs and resins, modified toxins and elixirs to cure fevers, remove bad humors, heal wounds and sell restore natural balances.
And much later would come the Age of Enlightenment at the close of the Middle Ages bringing along with several other scientific awakenings the idea that diseases were caused by germs and parasites and not the work of witches and mad gods.
Thus, would begin medicine’s golden age when the causal nature of such ancient scourges as Black Death, Tuberculosis and leprosy were quickly understood to be caused by preventable agencies. Further advances in this enlightenment came with the discovery of penicillin in the mid 20th century and this paradigm of a causal relationship between environmental forces and human maladies became a controllable and limit able transaction.
Yet up to this point medicine was reactive. The focus being the cure of diseases that have already taken root. Very slowly but surely this evolved and shifted to include the first principle of prevention as the first basis for disease control. A stitch in time always saves nine.
Public health policies in developed part of the world quickly assimilated these principles improving sanitation and drainages, mitigating disease spread by vector control and the use of
The chemical prophylaxis and vaccines where applicable leading to the successful reduction of such public health challenges as child hood measles and polio and in the case of small
Pox its complete eradication by 1980 per the World Health Organization’s declaration in the year.
Active medical care delivery is practiced by doctors. So, what was the nature of formal training for these highly valuable professional where preventive health principles are concerned?
Surprisingly the time honored and tightly structured curriculum of medical training would take a while to catch up with fats evolving concept but slowly the wisdom of a proactive health care delivery versus reactive slowly dawned on the medical education establishment and especially under the pioneering leadership of American medical faculties by the 70s preventive medicine was a recognized specialty in its own right with several intersecting disciplines such as public health, health care management and preventive practices in clinical health care delivery. Today it’s a widespread paradigm designed to promote protect and maintain health and well-being and to prevent disease, disability and death.
Stanza 2. Paradigm in action.
How effective are these when applied with a large foot print in a catchment community? Well, let’s do a quick comparative analysis of statistics from the Tier one Human development Index country such as Canada, where health care is publicly and universally covered, and a Tier 4 one like Nigeria where out of pocket is expenses still accounts for more than 15 percent of house hold expenditure, a universal hallmark of poor developmental status.
The Canadian health care practices a 5-point health coverage system. Health care coverage is:
- Publicly Meaning it’s operated on a Non for-profit basis by a government appointed agency.
- Comprehensive e. covers all medically mandated procedures and visits.
- Universal e. no preferential treatment. All are equal under it.
- Accessible; there must be no barriers to eligible residents getting coverage and
- Portable must be available to the residents everywhere they are inside Canada and abroad.
Given this comprehensive universality and with preventive health care practices consume the bulk of funding into this Canada health care scheme it is title wonder they boost a much more modest statistic of diseases and disability.
Example.
Average Life expectancy in Canada 81.3 years vs 67. years for Nigeria.
Another example – Canada used to get about 90k measles cases a year. before 1963 when they started a universal vaccination program against the measles virus. Today annual outbreak number are less than 100. In stark comparison Nigeria’s case report is still above 200,000 annually.
How about colorectal cancer, a grim malady that is preventable by a simple lab stool test and if indicated an equally easy to execute camera test called colonoscopy.
Annual rate in 2024 for Canada is about 25000 cases with deaths at about 9500 2024. The average 5-year survival is 66 percent. 66 of every 100 people diagnosed are still alive 5 years later.
In comparison Nigeria where though we have a much lower incidence rate at 3.7 per 100000 per which adjusted for population size gives about 925 a year. Yet this is counter balanced by the fact that our 1-year survival rate is 50 percent. 50 of every 100 people diagnosed are dead by one year mark a grim reflection of how advanced and late the disease is at the time of diagnosis.
The comparative data for heart attacks are similar reflecting the prevalent poverty of preventive care practices that would have reduced risk factors such an obesity, hypertension, high blood glucose and cholesterol etc. through timely, medically supervised interventions on nutritional adjustments and physical therapy as well and the early use of mortality and morbidity outcome modifying medications.
Stanza 3. Implementing Preventive health care principles.
So, what are the main ways we can benefit individually from the preventive health care paradigm? What and which applies to us? How do we improve this practice in our economically and developmentally changed environment? Valid questions one and all and am sure ones that are already burning in the minds of most if not everyone here.
First off, I sympathize with the urgency of the need for individual level information on this score but one could say I am duty bound to begin by quickly mentioning that our own personal efforts will be vitiated if the public scale solutions are not in first in place ie good sanitation, portable water supply, effective drainage systems, with reduced occurrence of open bodies of stagnant water, pest and rodent control and air pollution.
Recommendations for and discussions about individual level interventions are best done from the point of view of age and or gender-based analysis.
Children: for childhood being up to date with vaccination start doses and boosters are protective against the menace of childhood diseases such as measles, rubella, polio, Pertussis and TB. Also, regular attendance with the pediatrician supervised wellness baby clinics where there physical and mental developmental milestones are checked and measured so that early detection and corrections of childhood disorders such as autism spectrum disorder, ADD and dyslexia are diagnosed and corrected for on time.
Adolescents: For this group it’s mostly all going developmental screening with applicable vaccination boosters such as for diphtheria, tuberculosis and hepatitis. As well well novel vaccines like the HPV vaccines that have changed the game in cervical cancer outcomes in women worldwide given to children between the ages of 9 to 26.
Adult: BMI, blood pressure checks, vaccination boasters and adult age vaccine such as heroes zoster for shingles. Chronic disease prevention screening is paramount in the age group with the early detection and management of such cardiovascular risk problems like detection hypertension, diabetes mellitus, high cholesterol, obesity and cancer screening. Females benefit from regular screening for mammograms, cervical and ovarian cancers
Geriatric patients continue to need cancer screening, are eligible for vaccines like zoster, diphtheria and pneumovax for pneumonia as well as mobility and joint range assessment as well as cognitive testing hearing and vision.
Of course there are also universal prevention modalities. Universal as they apply to everyone.
Regular exercise at least 45 minutes of aerobics 5 minutes times a week, healthy diet, rich in vegetables and fruits and low in calories, fat and red meat. Micro nutrients supplementation is also key e.g. Vitamin D and calcium, omega 3, and iron rich foods.
Of note the fore running is called primary (preventing a disease from occurring) and secondary (screening for the early detection of diseases that are already there) prevention modalities.
Tertiary prevention are those measures that come in when the harm is already done e.g. post stroke or post heart attack, designed to reduce the risk of another event and or of disabilities there-from.
Conclusion.
Preventive health care paradigm is a much neglected but critically important part of health delivery in Nigeria. Strategies to prevent and detect the onset of health care dislocations save resources, improve quality of life and reduce the care cost burden on individuals, their families and the state. The individual is extremely wise to strive to implement these as much as possible in spite of the considerable strain on the domestic budget from health care tariffs
For its only by so doing that we can remain firmly on that gilded highway between health and happiness: the Royal Road.
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