Preconception care: a clinical case of "think globally, act locally".

In 1900 the life expectancy for a woman in the United States was 48.3 years; by 2004 that life expectancy had risen to 80.4 years.1 Most of the increase is attributable to improvements in nutrition sanitation and other public health efforts that are focused at the population level; however medical advances in secondary and tertiary prevention efforts that target individual patients also played a significant role. Despite evidence of the synergy between medicine and public health the full integration of these disciplines has never been realized. This dichotomy has fostered the perception that medicine cares for individuals and that public health cares for populations. At the clinical level health care practitioners often struggle with how to "translate" population-based risk data to the individual who is seated in front of them. To paraphrase the vernacular "think global act local" health care providers are grappling with the challenge to "think population treat individual." The concept and practice of preconception care epitomizes the difficulty and concurrent simplicity of translating population- based primary prevention data to individual patient care. (excerpt)