CASE

Y.S. is 24 year old white female medical student who presents to you in the student health clinic for her first visit. She has no complaints but just wants “a check up”. What services should we offer to prevent premature death, disability, and morbidity in a seemingly healthy young person?

We can begin by reviewing her life expectancy data and the leading causes of death for her cohort. A white 24 year old woman had a life expectancy at birth of 81.2 years of age, according to the National Vital Statistics 2011 report (data from 2009). The top ten leading causes of death for a 24 year old white female as compared to a 24 year old black female are:

Many of the leading causes of death on this table are related to modifiable behaviors such as tobacco use, poor nutrition, driving a motor vehicle, sexual behavior, drug use, firearms, and alcohol use.

In order to formulate a reasonable and tailored plan for health promotion and disease prevention in this patient, one must assess the patient’s age, sex, race, and risk factors. Risk assessment and identification emanates from a careful history and physical examination. If she is found to be in a certain “high risk” population, she may need preventive interventions that are different than the general population. For example, if our student was a 24 year old black female medical student, leading causes of death would include HIV disease and chronic lower respiratory diseases while cerebrovascular disease and diabetes drop on the list. Individual behaviors still dictate what is offered (e.g., a 24 year old black female medical student who was never sexually active; a 24 year old white female medical student with multiple unprotected male sexual partners).