Medicine, Health Care and Philosophy

, Volume 16, Issue 4, pp 691–697 | Cite as

Chronic disease, prevention policy, and the future of public health and primary care

  • Rick MayesEmail author
  • Blair Armistead
Review Article


Globally, chronic disease and conditions such as diabetes, cardiovascular disease, depression and cancer are the leading causes of morbidity and mortality. Why, then, are public health efforts and programs aimed at preventing chronic disease so difficult to implement and maintain? Also, why is primary care—the key medical specialty for helping persons with chronic disease manage their illnesses—in decline? Public health suffers from its often being socially controversial, personally intrusive, irritating to many powerful corporate interests, and structurally designed to be largely invisible and, as a result, taken for granted. Primary care struggles from low reimbursements, relative to specialists, excessive paperwork and time demands that are unattractive to medical students. Our paper concludes with a discussion of why the need for more aggressive public health and redesigned primary care is great, will grow substantially in the near future, and yet will continue to struggle with funding and public popularity.


Public health Primary care Prevention Chronic disease Integrated care 


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Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  1. 1.University of RichmondRichmondUSA
  2. 2.Department of Epidemiology and Community HealthVirginia Commonwealth UniversityRichmondUSA

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