Americans need to start a second public health revolution, one to prevent all disease, much as the first health revolution of the turn of the century attacked infectious disease, the government's chief health officials said yesterday.
Outgoing Health, Education and Welfare Secretary Joseph A. Califano Jr. and Surgeon General Julius Richmond released the first surgeon general's report on health promotion and disease prevention.
Califano said the document, nearly two years in the making, represented a medical consensus as important as the 1964 surgeon general's report on smoking and health.
The new report called on Americans to make momentous changes in their diet and habits to reduce their death rate by 20 to 35 percent, in various age groups, by 1990.
To do so, the report said, people should cut their intake of alcohol, salt, sugar and fats, especially foods containing saturated fats, largely solid or animal fats.
HEW thus officially joined the still controversial camp of the doctors who advocate low-fat diets to help prevent heart disease, to the displeasure of the meat, dairy and egg industries, which say there is no sure proof that their high-fat, high-cholesterol products can be harmful.
In concontrast to other such health reports, including many lesser ones in the Califano and earlier administrations at HEW, this report was issued with no fanfare whatsoever, despite its ambitious goals.
There were no new conferences, no media briefings or background documents, no news releases, no personal appearances by the secretary or surgeon general, only delivery of the basic document and Califano's written statement to news media.
Some health officials active in the report's preparation expressed great disappointment in the lack of advance publicity, and the failure of any health officials to go to the media to carry the report's message to the public.
All blamed the perceived failure on the confusion of the current HEW interregnum. HEW officials are largely waiting for secretary-designate Patricia Roberts Harris and her own team, with no one wanting to act too boldly on anything in the meantime.
This unusual reticence aside, the report represents an important consensus among doctors and medical scientists. A time has been reached, they say, when people can do far more to improve their health by acting themselves than they can by waiting for symptoms and then going to doctors.
Richmond emphasized in the report's text that it is presented only as a guide to citizens, who must make their own decisions. And Califano said the report remains purposely cautious and noncommittal about large, difficult questions of individual and political will.
Still, the report makes some controversial recommendations in addition to those for a leaner, less sweet diet.
It advocates wider use of amniocentesis - sampling the fluid in an expectant mother's womb to try to detect birth defects - even though, the report says, "detection of an abnormality may require a personal decision about an abortion."
To combat "the distressing problem" of unwanted pregnancy, the report recommends information about birth control measures for young people of both sexes. It recommends easily accessible family planning services, in other words, contraceptives for youths "who are sexually active."
Cigarette smoking, the report says, is the principal preventable cause of chronic disease and death in this country, and everyone should try to quit, or never start. But, the report adds, "Those who are unable or unwilling to stop ought to smoke brands low in tar and nicotine," as well as inhale less, smoke cigarettes only half way and gradually reduce their use.
The report also advocates action at individual, community and governmental levels to reduce the number of handguns. Gun control is another touchy political subject.
Among many other measures, the report recommends:
Moderate exercise, explained as vigorous exercise, if possible, at least three times a week for 15 to 30 minutes each time. Sedate people should increase exercise gradually. Anyone over 40 with a health problem should see a doctor first.
Obeying speed laws and use of seatbelts and motorcyclists' helmets, since road accidents are among the greatest killers. Also, the report said, don't drive after using alcohol or any mood drug - marijuana, PCP, cocaine are some - and don't get in a car with a user.
Get to a doctor or health center periodically - how often depends on age and sex - for screening for major disorders.
If most people do most of these things, the surgeon general said, the United States by 1990 can cut infant deaths by 35 percent, deaths of the young from age 1 through 24 by 20 percent and death among 25-to 64-year-olds by 25 percent - and reduce days of illness among older people by 20 percent.
All this, Dr. Richmond said, is within the country's "practical grasp."