a large segment of society by making them permanent objects of social beneficence, a status that few if any members of our society would wish to occupy."

Disability prevention requires a change in the perspective of physicians and other health care providers to broaden modern medicine's cure-oriented emphasis on acute illness. Often, people with disabling conditions cannot be cured, although this is not to say that they do not require acute care services. For these people, medical interventions are more appropriately viewed as playing an enabling, or empowering, role. The standard of successful treatment should be achieving a level of health and functioning that allows people with disabling conditions to manage their own affairs and to participate in society.

When viewed as a complementary element of disability prevention, health care can move in new directions. For example, treatment protocols, as recommended in the previous chapter, would consider not only medical needs but also necessary environmental modifications, the availability of family support, and other nonmedical variables. Thus health care should be viewed as only one component of an array of enabling interventions that have a common aim: whether social, environmental, or medical, the services provided to people with disabling conditions should seek to ensure a reasonable quality of life.

Similarly, attention to quality of life may point the way to new intervention strategies and better measures of rehabilitation outcomes. For example, significant recovery of intellectual capacity and motor function in people who have sustained severe brain injuries is generally considered to constitute successful rehabilitation. Yet a growing body of research indicates a high frequency of behavior disorders in this population, a problem rarely addressed in rehabilitation even though it is believed to be a major cause of job loss. A greater emphasis on measures of quality of life in evaluations of the effectiveness of rehabilitation might spawn greater awareness and understanding of the problem.

NATIONAL HEALTH PROMOTION AND DISEASE PREVENTION OBJECTIVES

The status and importance of public health and preventive medicine were enhanced significantly in 1979, when the Public Health Service promulgated 226 health promotion and disease prevention objectives to accomplish five national health goals by 1990 (U.S. Department of Health and Human Services, 1980a). Measured against 1977 benchmark statistics, these goals were to achieve the following: 35 percent fewer deaths among infants, 20 percent fewer deaths among healthy children between the ages of 1 and 14, 20 percent fewer deaths among adolescents and adults between the ages of 15



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