Challenges in Evidence Based Prevention

Prevention plays a critical role in all age groups. From a theoretic and practical perspective, however, greater emphasis should be placed on prevention in the earlier years because the potential benefit is greater. As people age, chronic diseases develop, and a greater proportion of health care becomes dedicated to disease management. Because prevention is most beneficial in the younger years, one would expect that the preventive services provided to children are supported by a strong evidence base. On the contrary, there is a relatively large evidence base for determining beneficial preventive services for adults, but aside from immunizations, the evidence base for childhood services is generally much more limited (Moyer and Butler, 2004).

Reasons for this lack of evidence base include length of follow-up required to realize reduction in disease outcomes, historical adoption and therefore standardization of many childhood preventive services, ethical considerations of not offering a potentially beneficial preventive service to children, methodologic challenges in determining developmen-tally appropriate outcomes in children, and the paradigm that knowledge alone represents a beneficial health outcome for families.

These evidence gaps in prevention highlight the challenge of child research rather than invalidate the importance of prevention in children. The message must be made clear to physicians, parents, and children—prevention is important at all ages. Several categories of preventive services are relevant to children: immunizations, counseling and anticipatory guidance, screening tests, and preventive medications. Chapters 22, 23, and 24 discuss care for children, including preventive services.

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