develop service delivery systems that prevent needless impairment and disability.

Overcoming the fragmentation, lack of coordination, and large gaps in essential service components that now characterize health care and social service programs will not be easy. However, effective delivery of services requires a focal point of continuing responsibility and accountability. It also requires freeing up funding from overly restrictive and overly rigid reimbursement schemes so that the particular service needs of individuals can be accommodated. For insurers and other third-party payers, this will necessitate determining how to work with providers of social support services and other services that are now excluded from the traditional medical model upon which most insurance coverage is based.

Thus it seems obvious that new funding arrangements are needed, as are new relationships among service providers. It is not clear what forms these new arrangements and relationships should take, although several models probably will be needed.

Primary care providers, public health agencies, private insurers, voluntary associations, and community organizations should undertake the development and evaluation of collaborative demonstration projects that are designed to provide comprehensive, coordinated disability prevention programs. Interventions should focus on individual needs, with the goal of improving quality of life and physical, mental, and social well-being.


Stereotypes are slow to die. In the area of disability prevention, however, clinging to outdated service delivery models and to disproved notions about the chronically ill and the elderly makes the prospects for progress quite poor. New thinking is required, and this can be achieved only through public and professional education.

More must be done in schools and in the home to instill in the young the importance of healthful behaviors. Health promotion, however, is relevant to all stages of life, and the themes are often the same (e.g., regular exercise, proper diet, avoidance of substance abuse, and injury prevention). Reinforcing messages in the community, the school, the workplace, and the physician's office can help create a social context that promotes healthful lifestyles. The change in public attitudes toward cigarette smoking clearly demonstrates that such constant reinforcement can have a positive impact on individuals, resulting in benefits for all of society.

Public attitudes toward the aging process have fostered an unduly pessimistic

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