PEDIATRICS Vol. 80 No. 3 September 1987, pp. 415-422
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Preventive Pediatrics: The Promise and the Peril

Leon Eisenberg MD1

1 From the Departments of Social Medicine and Health Policy and Psychiatry, Harvard Medical School, Boston

I was deeply honored to have been invited by the Canadian Paediatric Society to serve as its 18th Queen Elizabeth II Lecturer. Even as I relished the honor, I found it daunting, given the distinction of my predecessors. Having considered at length how best to respond, I chose to address prevention, a field with which pediatrics has been concerned since its inception as a specialty. Although the commitment of pediatrics to disease prevention has been unswerving, the diseases that have been the target of its efforts have necessarily changed as the distribution of disease in the population has changed and as scientific advances have created new opportunities for intervention.

What pediatricians were once almost alone among medical specialists in emphasizing has now become the target of government policy in Canada,1 the United States,2 and the United Kingdom.3 This, however, is not quite the triumph it may seem. Physicians who advocate prevention do so in the hope of avoiding unnecessary suffering and premature death for their patients. Politicians who do so may not be unmindful of these goals, but their primary motivation is controlling the costs of medical care. The US Forward Plan for Health2 was unabashed about it: "the primary focus of our program is a major attack on cost escalation." The differences in motivation between physicians and politicians have important consequences for health policy, consequences that imperil the promise of prevention.

Let me, then, begin with a few words of history, move on to the promise of preventive pediatrics in the years to come, and conclude by discussing the hazards associated with the use of prevention as a political rather than a medical slogan.

Submitted on October 20, 1986
Accepted on December 10, 1986




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