Preventing Disease, the offspring of an extraordinary collaboration between the U.S. and Canadian Preventive Services Task Forces, presents a meticulous and objective review of the published evidence on preventive measures. Examining such diverse and relevant topics as screening for endometrial cancer, exercise counselling for healthy adults, and the evidence for a causal relation between dietary lipids and coronary heart disease, this volume reflects the editors' shared conviction that recommendations for preventive action should rarely exceed what is well justified by the evidence. In the current period, characterized as the Second Public Health Revolution, the authors' hard-nosed approach leads them to ask the tough questions. Are preventive measures cost-saving? Does preventive screening actually lead to treatment in clinical practice? Does the treatment do more good than harm? To what extent does our desire to eliminate causes of serious disability, ill health and premature death cloud our objectivity? All concerned about preventive medicine, community health, and primary care will find valuable stimulation for thought and action in this book: the contributions have gone beyond the rhetoric.

Promoting human health and safety by reducing exposures to risks and harms through regulatory interventions is among the most important responsibilities of the government. Such efforts encompass a wide array of activities in many different contexts: improving air and water quality; safeguarding the food supply; reducing the risk of injury on the job, in transportation, and from consumer products; and minimizing exposure to toxic chemicals. Estimating the magnitude of the expected health and longevity benefits and reductions in mortality, morbidity, and injury risks helps policy makers decide whether particular interventions merit the expected costs associated with achieving these benefits and inform their choices among alternative strategies. Valuing Health for Regulatory Cost-Effectiveness Analysis provides useful recommendations for how to measure health-related quality of- life impacts for diverse public health, safety, and environmental regulations. Public decision makers, regulatory analysts, scholars, and students in the field will find this an essential review text. It will become a standard reference for all government agencies and those consultants and contractors who support the work of regulatory programs. Table of Contents Front Matter Executive Summary 1 Introduction 2 Characteristics of Major Regulations and Current Analytic Practices 3 Measures and Strategies for Obtaining Health Benefit Values for Regulatory Analysis 4 Beyond Ratios: Ethical and Nonquantifiable Aspects of Regulatory Decisions 5 Recommendations for Regulatory Cost-Effectiveness Analysis Appendix A Summary of Case Studies Appendix B Health Indexes Appendix C OMB Circular A-4 Appendix D Acronyms and Glossary Appendix E Biographical Sketches References Index

Adolescence is a time of major transition, however, health care services in the United States today are not designed to help young people develop healthy routines, behaviors, and relationships that they can carry into their adult lives. While most adolescents at this stage of life are thriving, many of them have difficulty gaining access to necessary services; other engage in risky behaviors that can jeopardize their health during these formative years and also contribute to poor health outcomes in adulthood. Missed opportunities for disease prevention and health promotion are two major problematic features of our nation's health services system for adolescents. Recognizing that health care providers play an important role in fostering healthy behaviors among adolescents, Adolescent Health Services examines the health status of adolescents and reviews the separate and uncoordinated programs and services delivered in multiple public and private health care settings. The book provides guidance to administrators in public and private health care agencies, health care workers, guidance counselors, parents, school administrators, and policy makers on investing in, strengthening, and improving an integrated health system for adolescents. Table of Contents Front Matter Summary 1 Setting the Stage 2 Adolescent Health Status 3 Current Adolescent Health Services, Settings, and Providers 4 Improving Systems of Adolescent Health Services 5 Preparing a Workforce to Meet the Health Needs of Adolescents 6 Health Insurance Coverage and Access to Adolescent Health Services 7 Overall Conclusions and Recommendations Appendix A: Acronyms Appendix B: Harris Interactive Omnibus Survey Questions Appendix C: Biographical Sketches of Committee Members and Staff Index

Vaccines have made it possible to eradicate the scourge of smallpox, promise the same for polio, and have profoundly reduced the threat posed by other diseases such as whooping cough, measles, and meningitis. What is next? There are many pathogens, autoimmune diseases, and cancers that may be promising targets for vaccine research and development. This volume provides an analytic framework and quantitative model for evaluating disease conditions that can be applied by those setting priorities for vaccine development over the coming decades. The committee describes an approach for comparing potential new vaccines based on their impact on morbidity and mortality and on the costs of both health care and vaccine development. The book examines: Lessons to be learned from the polio experience. Scientific advances that set the stage for new vaccines. Factors that affect how vaccines are used in the population. Value judgments and ethical questions raised by comparison of health needs and benefits. The committee provides a way to compare different forms of illness and set vaccine priorities without assigning a monetary value to lives. Their recommendations will be important to anyone involved in science policy and public health planning: policymakers, regulators, health care providers, vaccine manufacturers, and researchers. Table of Contents Front Matter Executive Summary Introduction Progress in Vaccine Development Considerations of Candidate Vaccines Overview of Analytic Approach and Results Review of the Analytical Model Ethical Considerations and Caveats Observations References Appendix 1: Borrelia burgdorferi Appendix 2: Chlamydia Appendix 3: Coccidioides Immitis Appendix 4: Cytomegalovirus Appendix 5: Enterotoxigenic E. coli Appendix 6: Epstein-Barr Virus Appendix 7: Helicobacter pylori Appendix 8: Hepatitis C Appendix 9: Herpes Simplex Virus Appendix 10: Histoplasma capsulatum Appendix 11: Human Paillomavirus Appendix 12: Influenza A and B Appendix 13: Insulin-Dependent Diabetes Mellitus Appendix 14: Melanoma Appendix 15: Multiple Sclerosis Appendix 16: Mycobacterium tuberculosis Appendix 17: Neisseria gonnorrhea Appendix 18: Neisseria meningitidis Appendix 19: Parainfluenza Virus Appendix 20: Respiratory Syncytial Virus Appendix 21: Rheumatoid Arthritis Appendix 22: Rotavirus Appendix 23: Shigella Appendix 24: Streptococcus, Group A Appendix 25: Streptococcus, Group B Appendix 26: Streptococcus pneumoniae Appendix 27: Information on accessing Electronic Spreadsheets Appendix 28: Summary of Workshops Appendix 29: Questions Posed to Outside Experts and List of Responders Index