La. Admin. Code tit. 48 § I-11527

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-11527 - Preventive Health

A. Definition/Description

1. Traditional definitions of health prevention are divided into three levels of activity: those which prevent the occurrence of disease or illness, those which intervene after disease is detected but before it is symptomatic, and those which prevent the progression of symptomatic disease or illness. Because there is lack of agreement among professionals about a clear definition of health prevention, an accurate and complete inventory of preventive health programs cannot be compiled. Another reason for the difficulty in assessing the scope of health prevention activities is that health-related and prevention-related activities are frequently subsumed under other functions (e.g. defense, security, natural resources, environment). Programs and activities in areas traditionally regarded as preventive include, but are not limited to, the following:

a. health education/information/research (human sexualtiy, contraceptive use, excercise, stress, behavioral problems);

b. direct preventive health services (family planning, immunization);

c. nutrition;

d. environmental protection;

e. occupational health and safety;

f. transportation safety;

g. home safety codes and standards;

h. recreational safety;

i. consumer product quality and safety (food, drugs, cosmetics, appliances, alcohol, tobacco, firearms, motor vehicles);

j. fire prevention.

2. There is strong consensus among various professionals and agencies concerning the need for and value of preventive health measures, because it has been proven that prevention reduces morbidity and mortality, improves the quality of life, and is cost-effective.

B. Relationship to Health Promotion and Health Protection

1. Health, because of its pervasive and illusive nature, has been defined by the World Health Organization in terms of its outcome: a state of complete physical, mental, and social well-being, and not merely the absence of disease and infirmity. This operational definition of wellness implies a balance of health promotion, health protection, and health prevention.

2. Of these three areas, health promotion is the most recent, and the least developed. Wellness and lifestyle programs directed toward health promotion require parallel development of risk, behavior, and intervention measures. Health promotion is an integral part of preventive health, and is addressed separately in this document. Health promotion was selected as one of the State Health Plan priority needs areas for 1982-87, in a statewide survey.

3. Health protection activities include regulation and enforcement, voluntary adherence to standards, infectious disease control, and surveillance and monitoring. These activities are dominant in the area of prevention, as they are intended to reduce exposure to a number of sources of hazards related to air, water, food, drugs, motor vehicles, and firearms; they cannot be isolated from health promotion and health prevention, and they often overlap.

4. Preventive health activities include an extensive array of procedures and services, provided to the individual by medical providers and other practitioners, which are designed to prevent disease or arrest its development. Examples of services are immunizations, screening tests, contraception, health and patient education, and counseling. For preventive strategies to be effective, activities must be targeted to and tailored to fir different settings (e.g. school, worksite, home, medical treatment setting, and community).

C. Scope

1. It is generally agreed that preventable health problems fall into three general areas of concern, for causes of morbidity and/or mortality: environment, lifestyle, and medical services.

2. Environmental factors are related to the influences and surroundings of home, work, and recreation. These settings or sources of external hazards increase the risk of health problems. Examples of the influences are food, water, transportation, pollution, consumer safety, occupational hazards, and communicable disease.

3. Lifestyle is the most difficult category in which to achieve results. Lifestyle is relative to an individual's personal behavior patterns, such as use of drugs, alcohol, and tobacco, nutrition, and physical fitness.

4. The area of medical services includes factors which influence health by preventing or treating disease or disability. Examples of preventive services (which can appear in a variety of settings) are immunization, genetic counseling, rehabilitation, dental services, early detection and treatment of chronic diseases, emergency services, family planning, prenatal and perinatal care.

D. Responsibility

1. The concept of health prevention concerns and interests everyone, but has no focus of responsibility. Ideally, prevention should become the prevailing element in medical care, with health maintenance, rather than cure, as the primary aim. Personal health care has been, and still is, essentially a complaint-response system, which is insufficient for complete health care. To change the emphasis from treatment of illness to promotion of wellness, a reorientation of medical practice and medical education is necessary.

2. Clarifying the requirements of a preventive lifestyle is the responsibility of various professions concerned with physical and mental health. However, preparing and convincing people to behave in healthful and safe ways is largely an educational responsibility. Through education, the largest possible number of individuals can conceivably learn to protect their own health. Preventive education of the general public and of the health professions is most effective when may agencies, institutions, businesses, and industries participate, although the schools have the overrall responsibility. Schools and pre-schools provide an effective setting for screening, diagnosis, counseling, basic health and nutrition education, dental health, accident prevention, mental health, and risk identification.

3. Participation of those being served is a key factor in preventive health; individuals must accept primary responsibility for their own health, instead of depending on physicians and other practitioners in the health care system. The ultimate responsibility for restoring, maintaining, and protecting optimal function lies with the individual. The intent of prevention is to return control for healthful and safe living to the individual.

E. Resource Goals

1. The goal of any prevention strategy is reduced disease and improved health. It is not feasible to quantify goals for prevention, or to mention every possible goal, due to the vast inter-disciplinary and interagency nature of preventive health. The following resource goals, although general, are intended to serve as initiatives in addressing the high priority problems in the state, and to contribute to enhanced physical and emotional well-being. The figures provided represent the most recent information available.

a. A population more aware of an actively seeking improved nutritional status and physical well-being through proper diet and exercise.

i. It is estimated that 1/3 of pre-school children in Louisiana do not receive recommended daily amounts of essential vitamins.

b. A population more aware of family planning principles, taking responsibility for preventing unwanted pregnancy, planning family size and spacing births, and considering age and health of parent:

i. Improved access to high quality fertility and contraceptive services, improved outreach and educational programs;

(a). in 1980, there were 234.3 illegitimate births per 1,000 live births in Louisiana;

(b). over 1/5 of the births in Louisiana each year are to girls aged 19 or younger.

c. Reduced incidence of morbidity and mortality associated with pregnancy and the neonatal and perinatal period, through increased awareness and availability of services:

i. in Louisiana, the percentage of low birthweight infants was 8.67 percent in 1979;

ii. Louisiana's infant mortality rate was 18.5 percent higher than the national average in 1979.

d. Reduced incidence of alcohol and drug abuse, and cigarette smoking, through increased awareness of the population of the harmful effects leading to morbidity and mortality:

i. it is estimated that there are 84,000 alcoholics in Louisiana;

ii. there were 27.8 deaths per 100,000 population in Louisiana with drug/alcohol related causes in 1979.

e. Reduced incidence of communicable disease:

i. increased immunization levels, through exposure in educational and informational services;

(a). 6 percent of all school age children in Louisiana are not current with their immunizations;

ii. control of sexually transmitted disease, through educational and information services, and early screening and diagnosis;

(a). Louisiana accounts for 2 percent of the cases of gonerrhea reported in the United States; 30 percent of the cases in Louisiana in 1977 were attributed to persons 0-19 years old; Louisiana has the second highest syphilis rate in the United States;

f. reduced incidence of chronic disease, with control through early screening, detection, and evaluation, and successful intervention when possible;

(a). reduced incidence and increased control of diabetes, respiratory disease, cardiovascular and hypertensive disease, due to changes in lifestyle and avoidance of known risk factors, and proper use of medical treatment;

(i). heart disease is the leading cause of death in Louisiana;

g. increased public and professional awareness of factors conducive to cancer and respiratory disease, and heightened efforts to remove or modify harmful environmental factors or modify personal habits;

i. Louisiana's age-adjusted death rate for cancer was 10 percent higher than the national rate in 1975;

h. A population increasingly aware of practical methods to avoid safety hazards and accidents in the home, workplace, and on the highway;

i. Louisiana ranks fourth in the nation in deaths caused by motor vehicle accidents;

i. A population increasingly aware of the need to preserve, protect, and improve the quality of the environment.

j. Increased public awareness of early symptoms of mental health and behavioral problems and knowledge of health system resources for early treatment.

La. Admin. Code tit. 48, § I-11527

Promulgated by the Department of Health and Human Resources, Office of Management and Finance, LR 13:246 (April 1987).

AUTHORITY NOTE: Promulgated in accordance with P.L. 93-641 as amended by P.L. 96-79, and R. S. 36:256(b).