Thursday, April 1, 2004
Healthy habits, immunizations, and vaccinations
By Dr. Anthony Policastro
Nanticoke Memorial Hospital

Public health efforts in this country have had many success stories. They have resulted in a decrease in death and disability from many diseases. The best example of that is immunizations. In the 1930s many children died from measles, diphtheria and whooping cough. While those deaths have disappeared, there is no way of knowing which children would have died today without immunizations. We cannot track prevention of disease by individual. We can only track the end results. There are fewer deaths than there used to be, so we have been successful. The only thing we can measure now is what percentage of school children are up to date on their immunizations. That number is close to 100 percent by kindergarten. The same thing is true of other healthy behaviors. We cannot track the individuals who have avoided disease. All we can track is the decrease in deaths and disability. For example, cigarettes cause lung cancer. Cigarette smoking rates have come down over the last 20 years. We can track those rates. However, since the development of lung cancer takes more than 20 years, we have not yet seen the success of decreased smoking in decreased deaths from lung cancer. We know that it will happen. We just have not seen it yet. We do know that in 1991, 23.8 percent of Delawareans smoked. That number decreased to 21.5 percent in 2000. That decrease will ultimately translate into decreased deaths from lung cancer. We just will not see it any time soon. Unfortunately, we will not be able to tell which individual ex-smoker avoided a case of lung cancer by quitting. There are other behaviors that we would like to encourage. We can look at how well we are doing in those areas over time. One success area has been increased use of seat belts. In 1991, 54.7 percent of Delawareans wore their seat belts. That number rose to 71.3 percent in 1997. There is no question that it saved lives. Some of the individuals whose lives were saved by seat belts in accidents during that period know who they are. Others cannot be sure. So while we saved lives, we do not always know exactly who was saved.
Pneumonia vaccination prevents fatal pneumonia in individuals over age 65. In 1993, the state rate for vaccination was 35.2 percent. By 1999 it had risen to 63.6 percent. There were lives saved over that time. We just canít be sure who those individuals were. Cancer screening is important. The rate for PAP Smears in the state in 1992 was 86 percent. In 2000, it was 90.2 percent. That means we have been doing a good job for many years in that area. Our approach to uterine cancer is good. For mammograms, the 1991 number was 67.1 percent. In 2000 it was 84.8 percent. This is now becoming an expected exam and therefore, the numbers were high to begin with and have risen even higher. Our approach to breast cancer is headed in the right direction. It is at a good level. We have not been as successful with colorectal cancer screening. In 1993, the state percentage was 28.9 percent. In 1999, it had risen to 43.8 percent. While this is encouraging, it is still not even close to uterine or breast cancer screening. There is a big opportunity to avoid death from colorectal cancer here. Eligible individuals need to take advantage of it. There is another area of bad news that I recently addressed. Obesity levels have continued to rise in the state. At the same time levels of physical activity have not changed at all. These are both areas that we can control. We cannot always tell which individuals have their lives saved by taking these preventive measures. However, we can frequently tell which individuals might not have died if they followed the correct measures. That is true for seat belts. It is also true for individuals who avoid cancer screening and wind up with incurable cancer by the time it is found. If you are going to be counted as a percent, it is better to be in the percent of the group that follows preventive measures than it is to be in the percent of the group that dies because they do not. The life you save may be your own.

Dr. Anthony Policastro is medical director at Nanticoke Memorial Hospital.