The role of medical care in contributing to health improvements within societies.

In attempting to assess the contributions of medical care to health improvements, the goals of care must first be addressed. The saving of lives in acute life-threatening emergencies is an important such goal, but it represents a very small component of the total medical effort: while lives are saved, the sum of such saving is too small to have a measurable impact on the life expectancy of an entire population. A much larger effort is devoted to preventive or curative measures, and these do have a large and measurable effect on the life expectancy of the population as a whole. An even greater component of medical effort is devoted to improving the quality of life, or more accurately, to preventing or to minimizing the poor quality of life associated with chronic disease: to the relief of pain, disfigurement, and disability. There are no population-based data to allow a direct estimate of the contributions of medical care to life extension or to the quality of life. In the absence of such data, my colleagues and I have created inventories of the outcome benefits of the preventive or curative care for individual conditions. Based on such an inventory of established life extending outcomes of preventive and curative services for individual conditions, I estimate that about half of the 7 1 ⁄ 2 years of increased life expectancy since 1950 can be attributed to medical care. I credit an even larger number of years of relief, or partial relief, of poor quality of life to medical care. The data on which the estimates are based are often incomplete, and the estimates are approximations. They are more than speculative and less than precise.