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:,. Statement of Purpose The ultimate answer to the problem of disease is prevention. In simple truth, a majority of the chronic illnesses and accidents which kill and afflict Americans can be considered preventable. By our own hand-by what we eat, drink, and smoke, and inactivity-we ruin our health and risk disease. By our actions and inaction, we literally invite the major chronic illnesses of heart disease, cancer, and stroke that wreak such human havoc. The more we learn of the conditions which lead to disease, the more we realize that good health care is an obligation which every person owes himself, his family, and society. It is an obligation which must be accepted by parents towards their children and by each person towards himself-but, unhappily, it is an obligation which most people fail to accept. Today, in the face of the health care crisis sweeping the United States, it is clear that a more prudent attitude toward health conservation is called for. It has become increasingly apparent that treating disease is simply not enough. The burden on society in suffering and economic cost is too great. Half our country's population is suffering from one or more chronicc diseases-with the annual cost estimated at a staggering $63 billion. The American Health Foundation was launched in 1968 as a national voluntary health agency to serve as a rallying point for advancing interest and action in preventive medicine. It was established with the conviction that our society needed an organization of r:

ofessionals and laymen to help foster a national )mmitment to the concepts and techniques of eventive medicine. Since the medical profession adily admits it sees little hope for solving the major oblems of the degenerative diseases by curative e Ine alone, the upgrading of disease prevention io _.a be a necessary, if not urgent, national priority. edicare and Medicaid and dozens of other laws dicate that citizen demand for medicine is almost iolly for curative medicine. To change this almost :clusive concern of the public and the health ofessions with the treatment of disease into a concern .1phasizing the importance of conserving health is e Foundation's primary objective. ost existing voluntary and official health associations the United States are concerned with the problem of )ecific diseases. While prevention is a component in e educational and research concerns of many of these -oups, the urgency and demand for treatment is usually ) great that it virtually monopolizes all organizational forts and available funds. iis neglect is matched by most medical schools, where e teaching of preventive medicine often has the lowest -iority, and where few medical students elect a career this practice. The neglect is also seen in government id private research laboratories where research in the :)tentially valuable area of preventive techniques is ighted, again and again, chiefly due to the limited 3signment of funds for such studies. k The American Health Foundation is seeking to counter- act this neglect. It is a lesson of history that hardly any disease of major significance has been effectively controlled by treating its victims after the symptoms have become cli~nically evident. Also underlying the Foundation's objectives is the fact that disease prevention is as scientifically sound as our knowledge of disease treatment. It is the belief of our founders that many illnesses can be more effectively controlled, and at far less expense, by preventive medicine than by current attempts directed at treatment and cure. To many experts, the present health care crisis facing the United States stems from the fact that the orientation of our entire medical apparatus is to meet the patient when he is already diseased-and when, no matter the sophistication of treatment, we can do very little to relieve his disability or extend his life. This "too much, too late" approach finds us making the least productive health investment possible, both in manpower and money. It has served to trap us into thinking that we can solve our nation's health problems merely by pouring billions of dollars into our present ineffective health care delivery system. To help meet this crisis, the AHF is working to make preventive medicine an integral and vital part of this country's health care system. The Foundation believes that preventive medicine offers an approach which will hasten the day when every American will not only live longer, but will gain useful longevity, unencumbered by the debilitating effects of chronic illnesses.

A National Program The American Health Foundation seeks to enhance the role and advance the practice of preventive medicine through a threefold program of health research, motivation, and care. Health research means epidemiological, applied and basic laboratory research with emphasis on its application to man. Health motivation means instructing and motivating persons to improve their health attitudes and habits and to encourage them to press for the modification of consumer products and environmental factors which are ,wn to be hazardous to health. Health care is the Foundation's promotion of periodic health testing of well people as a preventive medicine- technique. This concept is embodied in the Health Surveillance Center which theAHF plans to operate to demonstrate the most feasible, effective and practical methods of health testing by the use of automated equipment and computerization. Q Health Research The American Health Foundation has an intramural research program. The decision for this type of research commitment, which is unusual for a voluntary agency, came about because of what our trustees see as the need to overcome the woeful neglect of preventive medicine research. A strong in-house research program is also viewed as a way to give impetus and direction to preventive medicine research by others, and certainly such a research capacity will tend to strengthen the Foundation's educational and health care programs. A major objective of AHF research is "managerial" preventive medicine. This approach aims at environ- mental improvement through identifying and modifying those factors in products which are found to be injurious to health. The Foundation's basic and a-pplied research program also seeks to detect the earliest biochemical and physical abnormalities indicative of disease and determine methods of reversing them before serious damage is done. The AHF also conducts epidemiolog- ical studies with special focus on identifying high disease risk groups. Most of the research program is conducted in the American Health Foundation's Health Research Institute, located in our New York City headquarters at 2 East End Avenue.

4,6 -he five divisions of the AHF Health Research nstitute are: \ n :pidemiotogicaf Studies-investigation of chronic non- :ommunicable diseases of man to establish their nr )nce in certain population groups; and to identify im. .,etermine disease risk factors and learn if their eduction or removal will lead to a reduction of disease. :nvironmental Toxicology-research ranging from -ivestigations into the effects of tobacco smoking, with ~mphasis on work towards a less hazardous cigarette, to . ne effects of air pollution. 4utritional Biochemistry-investigations into the -ifluence of nutrition on major chronic diseases, such :s atherosclerosis and a variety of cancers, how dietary actors contribute to disease risk, and what dietary nodifications may offer protection. 'heoretical Carcinogenesis-basic research approaches o advance the understanding of cancer through the tudy of chemical and physical factors. , :xperimental Biology and Pathology-biological and )athological screening of data secured from the above reas; also, research studies of cell membranes and ~~ ubcellular particles believed to be fundamentally ivofved in a variety of diseases. k Health Motivation It is a matter of record that most people find it difficult, or even impossible, to maintain health habits which can protect them against illness and increase their life expectancy. This relates in part to the failure in health instruction in our public school systems, which has left most Americans indifferent and apathetic toward follow- ing the most rudimentary disease protection practices. This is unfortunate since our present knowledge of the natural history of many diseases is sufficient to make an important contribution to protecting against their occurrence. But this knowledge must be applied. Preventive medicine is people medicine. It cannot be effective if practiced by the physician alone. This is the reason why a major thrust of the American Health Foundation program is to foster personal preventive medicine. Ours is the job of educating and motivating individuals to adopt prudent health habits- and to support public action to improve environmental and social conditions which contribute to ill health and disease. In this manner, preventive medicine places a major responsibility on the individual, both as a private citizen and as a member of the community. To aid in the development and promotion of health education information, the Foundation has established special committees to study the concepts of preventive medicine as they relate to food and nutrition and to health motivation.

Most of the major causes of death (Figs. 1 and 2) in the United States are non-communicable diseases that take years, probably decades, before they present clinically-evident symptomatology. When symptoms have occurred, effective cure is f,requently no° nossible and, in economic terms, treatment u. rtaken is very costly. , 0 Age ~ FIVE LEADING CAUSES OF DEATH BY AGE U.S. MALE, 1966 Percent of Total Deaths 20 40 60 80 100 Death Rate for AII Causes 5-34 ~U~~~26 91j:::9:E1 203.1 35-44 92c? : 10 f5-54 ti Heart Disease ED Cancer 0 Car Accident 0 Diabetes E3 Stroke m Cirrhosis M OtherAccident E3 Suicide M9 Influenza & Pneumonia ED General Arteriosclerosis IM Homicide 392.3 979.1 Age 25-34 35- 44 45-54 55-64 65-74 75-84 FIVE LEADING CAUSES OF DEATH BY AGE U.S. FEMALE, 1966 Percent of Total Deaths 20 40 60 g0 100 Death Rate f or All Causes / ._ 13~ i ~~ N Heart Disease E3 Cancer E2 Stroke EJ Cirrhosis ® Influenza and Pneumonia 0 Car Accident 0 Diabetes ® OtherAccident 0 Suicide 0 General Arteriosclerosis 106.8 233.0 519.8 1,119.8 2,806.6 6,964.3 =ig• 1 Fig. 2

J AHF Committee on Food and Nutrition The Committee on Food and Nutrition consists of experts representing various groups which share a direct ^oncern and responsibility in the area of diet and ~alth-the nation's food industry, federal government, public health agencies, communications media, advertising agencies, hospital and university nutrition departments, and the lay public. The committee's general objectives are to: stimulate the dissemination of sound information pertaining to desirable foods and eating patterns to the public through the media encourage the food industry to process and formulate commercially packaged foods to reflect the existing knowledge of nutritional requirements for good health assist governmental agencies in identifying those areas of existing food regulations which are not consistent with current nutritional objectives promote the adoption of sound nutritional criteria in menu planning by all segments of the mass feeding industry. AHF Health Motivation Committee To deal with the equally serious problem of health motivation, the AHF Health Motivation Committee is evaluating the causes of health attitudes. Its broad objectives are to develop programs which will serve to: create public demand for preventive medicine. promote individual health care-especially periodic health examinations make the concepts of preventive medicine understandable and desirable.

Health Care The Foundation has also been developing plans and guidelines for a Health Surveillance Center to demonstrate preventive medicine techniques and especially periodic health testing. The Center will be principally concerned with primary prevention of disease risk factors in healthy client populations. It will also serve to evaluate automated health testing equipment used in conjunction with computerization and data analysis, and to provide data for epidemiological research and a practical basis for: eloping standards and performance guidelines for: multiphasic clinic operation health screening tests and methodology appropriate follow-up care technical training of clinic personnel. Identifying health criteria, such as health normalcy factors. Conducting a cost benefit analysis of screening programs. Establishing the research function of a multiphasic screening system. Determining new tests for the identification of high-risk patients and for early disease diagnosis. A National Organization : The American Health Foundation enjoys a non-profit and tax-exempt status under the laws of the State of New York where it was incorporated in April, 1968, after two years of organizational effort. Its activities are directed and monitored by a Board of Trustees and a Board of Scientific Consultants. The Foundation expects to function in close liaison with the National Institutes of Health, the American Public Health Association, the American Heart Association, the American Cancer Society, the Department of Agricul- ture, the College of Preventive Medicine, and other groups, both governmental and private, which share its special concern. Preventive medicine is the task of our total society- the legislative branches of government, voluntary health organizations, education, industry, the health profes- sions, the communications media, and the man in the street. The American Health Foundation seeks to serve as a catalyst to bring together the various parties interested in health care. While its major role is advancing the scientific principles of preventive medicine, it is equally dedicated to promoting the acceptance of new knowledge in this area by the medical profession and the general public. / 3

/ The American Health Foundation Board of Scientific Consultants George James, M.D.,M.P.H., Chairman Dean The Mount Sinai School of Medicine "It may be in the nature of man to find the present reality of dra- matic cures more fascinating than the invisible forces of pre- vention, but it is to these that the medical art of tomorrow must be directed." George James, M.D. Sol R. Baker, M.D. Associate Clinical Professor of Radiology University of California at Los Angeles Lawrence Bergner, M.D. Assistant Commissioner for Research and Professional Training New York City Department of Health Lester Breslow, M.D., M.P.H. Chairman, Department of Preventive and Social Medicine, School of Medicine University of California at Los Angeles Gilbert Cant Medical Editor and Consultant, Time Magazine John Cassel, M.D., M.P.H. Department of Epidemiology, School of Public Health, University of North Carolina Jerome Cornfield Research Professor of Biostatistics, 'iniversity of Pittsburgh Rene J. Dubos, Ph.D. Professor, Rockefeller University William L. Evers, Ph.D. Consultant for University Resources Alvin H. Freiman, M.D. Chief, Division of Medical Systems Memorial Hospital for Cancer and Allied Diseases . Takeshi Hirayama, M.D. Chief, Epidemology Division, Japanese National Cancer Center Marvin Kuschner, -M.D. Professor & Chairman, Department of Pathology, Health Sciences Center, State University of New York at Stony Brook G. E. Livingston, Ph.D. Professor and Director, Food Science Program Institute of Human Nutrition, Columbia University Gotthard Schettler, M.D. Professor of Medicine, Univ. Heidelberg Morton K. Schwartz, Ph.D. Chairman, Department of Biochemistry, Memorial Hospital for Cancer and Allied Diseases Fredrick J. Stare, M.D. Chairman, Department of Nutrition Harvard University School of Public Health Theodore B. Van Itallie, M.D. Director of Medicine, St. Luke's Hospital Center The American Health Foundation Officers and Trustees David J. Mahoney, Honorary Chairman President Norton Simon, Inc. William J. Levitt, Chairman Chairman of the Board Levitt & Sons, Inc. Ernest L. Wynder, M.D., President Thomas J. Ross, Jr., Secretary Vice President American Airlines, Inc. Warner G. Cosgrove, Jr., Treasurer Managing Partner Shields & Company ; Louis V. Aronson, II ° President Ronson Corporation Mrs. Charles A. Dana Walter E. Hanson Senior Partner Peat, Marwick & Mitchell George James, M.D., M.P.H. Dean Mount Sinai School of Medicine John H. Mitchell President Screen Gems Corporation G. William Moore President Fieldcrest Mills, Inc. Joseph M. Murtha President Sandgren & Murtha, Inc. Robert R. Pauley Maxwell M. Rabb Partner Stroock & Stroock & Lavan Fredrick E. Rathgeber Executive Vice President Prudential Insurance Company of America David L. Davies, Executive Vice President

tlOAFtD OF TRUSTEES ~ i Qsrd J r`!ahoney (Chairman) t 1.:•t,'r+ a n~!f. Inc. ~ t r t•aan. C.t torma 3 Inc. +...e ~ ..~F V . 4 , Louis V. Aronson 11 President Ronson Corporation Woodbridge, N. J. Warner G. Cosgrove, Jr. Managing Partner Shields & Company New York, N.Y. William J. Levitt G. William Moore Joseph M. Murtha Chairman of the Board President President Levitt and Sons, Inc. Fieldcrest Mills, Inc. Sandgren & Murtha, Inc. Lake Success, N.Y. Spray, North Carolina New York, N.Y. ~ nr.a In.~...~v.. R Inc. t- Maxwell M. Rabb Partner Stroock & Stroock & Lavan, attorneys New York, N.Y. rr Thomas J. Ross, Jr. Vice President-New York American Airlines, Inc. New York. N.Y. Efd Ernest L. Wynder, M.D. Pound Ridge, N.Y. s i I

\ Lester Breslow, M.D. Arofessor of Health Services kdministration School of Public Health Jniversity of California at Los Angeles rF'ubtic Healthl 4fvin Freiman, M.D. '.hief of Cardiology Aemorial Hospital for Cancer and 41lied Diseases Cardiovascular Disease) ~'^ .•~ • - :.: Gilbert Cant Eric J. Cassell, M.D. Eugene E. Cliffton, M.D. Medicine Editor Clinical Associate Professor of Chief, Clotting Mechanisms Section Time Magazine Community Medicine Sloan-Kettering Institute for (Communications) The Mount Sinai School of Medicine Cancer Research (Air Pollution) (Blood Coagulation) Herman E. Hilleboe, M.D. De Lamar Professor, Columbia University School of Public Health and Administrative Medicine (Public Health) Takeshi Hirayama, M.D. Chief, Epidemiology Division Japanese National Cancer Center Research Institute (Cancer) V V a*4;hQ • ^ i :. •:~• George James, M.D. Dean, The Mount Silfai School of Medicine (Public Health) <yt e Gotthard Schettler, M.D. Albert S. Thompson, Ph.D. Theodore B. Van Itallie, M.D. Joortscaster Professor of Medicine Professor of Psychology and Education Director of Medicine qBC Sports University of Heidelberg Chairman, Department of Psychology St. Luke's Hospital Center Physical Fitness) (Cardiovascular Disease) Teachers College, Columbia University (Nutrition) (Counseling and Personnel Psychology) :