Prevention Diaries: The Practice and Pursuit of Health for All

Book Title: Prevention Diaries: The Practice and Pursuit of Health for All

Book Author: Larry Cohen

Publication Information: New York, Oxford University Press, 2017, 249 pp., $24.95, hardcover

As family medicine physicians, we are able to change lives in increments of clinic visits. We treat diseases and, if we’re lucky, are able to improve health. Larry Cohen has taken this same mission over the course of his career to improve the health of millions and prevent illness and injury before it begins.

Have you ever wondered how car seat laws became the norm? Or how indoor smoking bans became commonplace? Wondered about the downstream effects of systemic violence? In Prevention Diaries: The Practice and Pursuit of Health for All, Cohen masterfully ties together personal narrative from his 30 years of field experience with hard facts to illustrate the importance of public health efforts in improving our collective health. More importantly, he demonstrates the profound impact that can be made with a little bit of passion and a lot of hard work.

Cohen begins with a key concept of prevention—the notion that “upstream” thinking, or understanding why an issue is occurring, is critical in finding the solution. He goes a step further to illustrate the financial benefits of such thinking. For example, dollars spent to prevent exposure to lead paint not only prevented harm, but also saved exponential dollars for associated complications, including criminal justice and educational support.

He goes on to illustrate how even insurmountable problems can be tackled by taking smaller steps to eventually establish a new norm. Using examples of both smoking and car seats, he illustrates the “prevention take-back test: even if the legislation were to change back now, most people would probably continue to use car seats because the law established a new norm” (p. 29). The financial importance of combatting these large issues further proves the point, both to readers and to decision-makers. Between medical costs and costs of missed work from accidents, car seats have a “13-to-1 return on investment” (p. 106).

While it is easy to focus on practicing medicine as the main way to foster health, Prevention Diaries reminds us that patients do not exist in a vacuum. In discussions of violence, environment, nutrition, and the social determinants of health, Cohen reminds us that health care providers work in much the same way as preventionists: “track back from the clinical concern, uncover the cause of the problem, and determine the right treatment to arrest it” (p. 31). Prevention Diaries presents a moving introduction to prevention, and why it is so important to begin addressing even the largest of problems. Moreover, it reminds physicians to “think upstream” and widen our differential for everyday health concerns.