Prevention in 1989: the state of the nation

Substantial gains have been made in the health of Americans since 1970, notably the 50% decline in infant mortality; the increase of nearly 4 years in life expectancy for both men and women; the declines in stroke and coronary heart disease mortality of 54% and 43%, respectively; the decline of injury deaths by about 30%; and the decline in deaths from nontobacco related cancers by about 10%. These improvements in the overall national health profile have been accompanied by enhanced public awareness of the relationship between behavior and health outcomes as well as sustained behavior change among certain groups. On the other hand, the research advances of the last two decades have given the nation an even keener understanding of how short of our full potential we are falling. International comparisons as well as data on the status of minority and disadvantaged groups in the United States confirm some of these shortfalls--in particular with respect to infant mortality, diabetes, motor vehicle deaths, suicide, and homicide. The complex etiologies of these problems require the forging of strong alliances with sectors outside the health arena, such as business and education, to seek solutions.