Patient Enpowerment

"Prevention" by definition implies that the end goal is to eradicate chronic illness, but I'm not sure if this is the best approach. Though many chronic illnesses are behavior-related (obesity is the prime example), I still feel that the majority are simply unavoidable consequences of aging. In the developed world, where the average lifespan keeps increasing year after year, it's no surprise that conditions such as diabetes, osteoporosis, and high blood pressure are also on the rise.  The contrast between developed and developing nations is shocking: while most of us die on ventilators in our old age (due to chronic obstructive pulmonary disease, high cholesterol, or any number of relatively managable conditions), people in the third world die abruptly of parasites, flesh-eating bacteria, cholera, and other infectious diseases over which they (as individuals) have little control.

Our healthcare system may have been founded to fight infectious disease, but now, as a developed nation that is no longer threatened by flesh-eating bacteria, etc., our healthcare system is rapidly becoming antiquated. 

Unlike infectious diseases, chronic diseases can't be "eradicated" in the traditional sense. I feel that chronic illness will always be present in one way or another, even if that "illness" amounts to nothing more than nature taking its course as we enter our 50s and 60s. Many people will make a conscious choice between their health and the other important aspects of life that might compromise that health--such as choosing to get 4 hours of sleep a night for a week straight in order to write grants (I'm looking at you, Greg...). So the notion of eradicating chronic illness altogether is a bit extreme.

What might make more sense for Western medicine in general is to change our system of healthcare delivery to encourage patients (rather than doctors) to take up the burden of care. With so much medical technology and free-flowing information at our disposal, I don't think it's unreasonable to move towards a delivery system in which patients play a much greater role in managing their own health. Medical paternalism is rapidly becoming an antiquity, and if we don't move completely away from it soon, it may very well become a liability.