A communitarian ethical model for public health interventions: An alternative to individual behavior change strategies

HE problem of premature death, defined for the purposes of statistical comparison as death before the age of sixty-five, is one which presents a serious threat to Americans, r I r analysis by Vaupel indicates, by comparison to other countries, how significant the problem is. The United States ranks twenty-sixth among all nations in survival rates to age sixty-five, behind Bulgaria, Puerto Rico, and Hong Kong (1). At the same time, Vaupel points out that the life expectancy for Americans at age sixty-five is just behind that of Sweden, which has the highest life expectancy in the world. This disparity makes the point clearly that the problem is truly one of premature death. Another way to state the problem dramatically, as Vaupel has done, is to indicate that the risk of premature death in the United States is 25%; one of four Americans dies before reaching age sixty-five (1). Presented in this way, early death becomes a problem equal to or greater in magnitude than any we as a society or as individuals face.