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The next major advances in the health of the American people will result from the assumption of individual responsibility for one's own health. This will require a change in lifestyle for the majority of Americans. The cost of sloth, gluttony, alcoholic overuse, reckless driving, sexual intemperance and smoking is now a national, not an individual responsibility. These abuses are justified on the ground of individual freedom, but one man's freedom in health is another's shackle in taxes and insurance premiums.
In the 17th and 18th centuries, moral and astrological factors were supplanted by theories that attributed disease to mental states, heredity, unknown poisons, environmental factors ("airs and waters"), contagion by mysterious poisons ("miasmata") and infection by animalcules ("germs" described by the early microscopists). With Pasteur's work in the late 19th century, a unitary theory of disease developed as a natural concomitant to the germ theory of disease: single organism, single disease, single cause. With further research, we have come full circle to colonial beliefs. It is now realized that there are multiple causes of disease, involving varying combinations of genetic factors, environmental factors (levels of stress, pollutants, germs and parasites) and behavioral factors (rest, smoking, exercise, diet, alcohol and hygiene).
When all is said and done, death and disease are inevitable, and as we eradicate one scourge, another will take its place. Ethical and moral concerns will have to play an increasing role in guiding us through lives of quality. These concerns will be matched with a typically American hardheaded pragmatism that tells us health care is only one element in the quality-of-life equation and the other elements, which depend on national will and individual responsibility, are equally important, if not more so.