Life expectancy at birth in the United States has increased 31.4 years, from 47.3 years in 1900 to a record high of 78.7 years in 2010 (Centers for Disease Control – CDC, National Vital Statistics Report Volume 60, Number 4, January 11, 2012). Although some of this progress can be attributed to advances in medical sciences and technology, public health investment in prevention has had the largest contribution to this improvement. The advent of safer workplaces, improved housing, better sanitation, nutrition initiatives, and mass immunization programs has significantly improved length and quality of life (Bunker, 1994). Infectious diseases that ravaged children and the elderly 100 years ago are less common today. Increasing knowledge about modifiable risks such as tobacco smoking, lead paint exposure, and unprotected sexual activity also had great impact on the health outcomes of individuals, entire communities, and the nation. Approximately 50-60% of the reduction in cardiovascular deaths observed in the US and Europe between the 1970s to 1990s is attributed to risk factor reduction, as opposed to medical treatments for existing disease (Hunink et al 1997; Capewell, et al 1999; Unal et al, 2004).
In spite of this, the American health system has increasingly put a higher priority and financial emphasis on treatments and practices targeted at advanced end-stage diseases that are often not cost-effective, and in many cases serve the needs of a very few. There are several initiatives at grass roots community levels, private sector, medical institutions, public health departments, and State and Federal governments to return to prevention as the backbone of medicine. The next generation of medical students will be expected, as part of the changing health care system, to provide preventive health services for individuals, families, and society.