ABSTRACT
Historically in American health care, the physician has assumed primary responsibility for an individual’s care during times of illness. The patient passively awaits the doctor’s judgment, perhaps in anticipation of an instantaneous cure. The healthy individual, on the other hand, generally takes his/ her physiological state for granted. This reliance on the family physician as primary change agent was reasonable and necessary prior to the 1960s, considering that infectious diseases were the number one health problem in the U.S. (Sultz & Young, 1997; Wodarski et al., 1991). At the dawn of the age of antibiotics, however, the public health burden shifted to those chronic diseases that have been related to unhealthy lifestyle choices. In fact, according to the Center for Disease Control, the top ten leading causes of death, up to 70 percent, are related to lifestyle or preventable illnesses (Rains & Erickson, 1997). In conjunction with this shift, the illness industry has seen major growth in the United States. Health care expenditures account for nearly 16 percent of the gross domestic product (Sultz & Young, 1997), while federal and state service programs grew 1,760 percent, or 32.3 billion dollars, from 1960 to 1985 (el-Askari et al., 1998); however, even with this increased funding, many public health problems have continued to increase. Health costs are rising 1 percent annually.
