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Prevention neglect. A utopian vision or time for a new social health contract?
  1. Raúl Mercer
  1. CEDES (Centre for Studies of State and Society), Sanchez de Bustamante 27, Buenos Aires, Argentina; rmercercedes.org

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    Since the founding of the medical contract, several series of ethical norms based on the Hippocratic oath (460-370 bc) have been oriented to provide health care to those who are in need. The professional practice has generated some problems such as negligence (lack of due diligence or care; omission of duty; heedlessness), iatrogenia (disease produced as a consequence of medical or surgical treatment), or new modalities under the scope of the so called medical errors (http://www.ahrq.gov/qual/errorsix.htm).

    When these problems are considered from the preventive point of view, the matter is not clearly solved, particularly in developing countries, where prevention has not reached a peak value. This gap can be explained by multiple factors and determinants that range from lack of health literacy to the absence of political awareness on the potential consequences of the omission of effective preventive interventions on a population’s health.

    From the individual perspective and for certain groups of diseases, a set of clinical preventive services can be provided by the health system with verified benefits1: screening, immunisations/chemoprophylaxis, and counselling. Community based interventions2 and public policies were also validated in terms of their effectiveness.3

    In developing countries, the right that a citizen has to claim for clinical preventive services or preventive public policies is not met with the same vehemence as with medical care. It is probable that both factors have a common denominator: absence of debate on setting health priorities and an impoverished society, especially in terms of civil rights.

    Some vignettes coming from developing countries can enlighten the discussion: (1) 20 years ago, the death of a child by measles was accepted as “natural”, (the same situation today can ignite an institutional-political conflict),4 (2) women dying because of lack of accessibility to screening programmes for cervix cancer as an expression of the inequity in the access to preventive care, (3) poor health attributable to lack of health literacy in sexual and reproductive health behaviours as a proxy indicator for low coverage in health counselling activities to prevent sexually transmitted infections, (4) lack of state policies and regulations against tobacco as the most important contributing factor for the dissemination of the tobacco epidemic.5

    The question is: Can prevention needs be transformed into a human rights issue or, should the omission of effective preventive interventions be interpreted as a matter of negligence? Perhaps this is the moment to coin the term prevention neglect as an alternative concept to redefine the contract between policy makers, healthcare providers, and the community as a way to describe the cost of doing nothing.

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