One of the greatest killers in the Western world is heart disease. The death rate from the disease has been increasing at an alarming speed for the past thirty years. Today in Britain, for example, about four hundred people a day die of heart disease. Western health-care systems are spending huge sums of money on the surgical treatment of the disease.

This emphasis on treatment is clearly associated with the technological advances that have taken place in the past ten to fifteen years. In this time, modern technology has enabled doctors to develop new surgical techniques and procedures. Many operations that were considered impossible a few years ago are now performed every day in U.S.hospitals. The result has been a rapid increase in heart surgery.

Although there in no doubt that a large number of people benefit from heart surgery, critics of our health-care systems point out that the emphasis on the surgical treatment of the disease has three clear disadvantages. First, it attracts interest and financial resources away from the question of prevention. Second, it causes the costs of general hospital care to rise. After hospitals buy the expensive equipment that is necessary for modern heart surgery, they must try to recover the money they have spent. To do this, they raise costs for all their patients, not just those patients whose treatment requires the equipment. The third disadvantage is that doctors are encouraged to perform surgery - even on patients for whom an operation is not at all necessary - because the equipment and surgical expertise is available. A federal government office recently said that major heart surgery was often performed even though its chances of success were low. In one type of heart surgery, for example, only 15 percent of patients benefited form the surgery.

In the recent past, medical researchers have begun to emphasize the fact that heart disease is associated with stress, smoking and a lack of exercise, and we can often reduce the risk of heart disease by paying more attention to these factors.

More and more people are realizing that there is a connection between heart disease and the way they live. As a result of this new awareness, attitudes toward health are changing. In the past, people tended to think that it was sufficient for good health to have a good doctor who could be relied on to know exactly what to do when they became ill. Now they are realizing that merely receiving the best treatment for illness or injury is not enough. They are learning that they must take more responsibility for their own health. Today many people are changing their dietary habits and eating food with less fat and cholesterol. Many are paying more attention to reducing stress in their lives. The number of smokers in the United States is now far below the level of twenty years ago as many people succeed in breaking the habit and as fewer people take it up. More and more people are aware of the benefits of regular exercise like walking, running, or swimming; some have begun to walk or ride bicycles to work instead of driving. Millions have become members of health clubs and have made health clubs one of the fastest growing businesses in the United States today. And now the beneficial effects of these changing attitudes and behaviors are beginning to appear: an encouraging decrease in deaths from heart disease.

心脏病是西方世界的最大杀手之一。在最近三十年以前，心脏病的死亡率正在以惊人的速度上升。例如，今天在英国每天大约有四百人死于心脏病。西方的各级卫生保健机构在心脏病的外科手术治疗方面正在耗费大笔的金钱。

这种老是强调治疗的作法显然与最近十到十五年内技术的进步有很大关系。在这一段时期内，现代技术使医生们研制出了一些新的外科手术方法和程序。两三年前还认为是不可能做的很多手术，现在在美国的各大医院里每天都在做。其结果就使对心脏实行外科手术的病例迅猛地在增强。

尽管有很多人从心脏外科手术中得到了好处，还是不容怀疑的；但是，对我们的医疗保健机构提出批评的人士都指出，强调用外科手术治疗心脏病的作法很明显有三大害处。第一，这种作法使得人们在兴趣和财力资源的分配上忽略了预防心脏病的问题。第二，这种做法导致了一般的医疗费用的上涨。各医院都购置了从事现代心脏外科手术所必须购置的昂贵设备之后，这些医院必须千方百计收回花费在这些设备上的购置费用，而不仅仅是提高了需要使用这些昂贵设备来加以诊治的患者们的费用。第三个害处就是鼓励医生去开刀--甚至对那些根本不需要动手术的病人也给开了刀--因为，要弄到一张专家同意手术的鉴定书、要使用这些设备都是唾手可得的。美国联邦政府办公厅最近宣布说即使成功的机率很低也还要经常对心脏动用外科大手术。例如，有一种外科手术，只须15%的患者在手术后病情有所好转。

最近这几年医学研究人员们开始强调这样一个事实，即心脏病与人的精神紧张、吸烟成癖，缺乏锻炼有密切关系，如果多加注意这些因素我们通常都能降低患心脏病的机率。

越来越多的人意识到人们的生活方式与心脏病之间有密切的关系。由于认识到了这一点，人们对待健康的态度正在转变。过去多数人都有这样一种看法：变为当人们生病以后，只要能有一位可以信赖的好医生，这位医生能确切地知道该怎么治，这对保障一个人的健康来说已经足够了。现在人们认识到伤病以后仅仅能得到最好的治疗是很不够的。人们已经知道了自己应当对自己的身体更加负起责任来。今天许多人正在改变饮食习惯，人们都吃低脂肪低胆固醇的食物。许多人更加注意减少生活中精神紧张的压力。美国现在吸烟的人数要比20年前少得多，因为有许多人成功地戒掉了这种恶习，还因为开始尝试吸烟滋味的人也越来越少。还有越来越多的人尝到了像走路、跑步、游泳之类的按时锻炼的甜头。有些人开始步行或骑自行车上班而不坐汽车。数百万人已经成了健身俱乐部的会员，这就使健身俱乐部成为今日美国发展最迅速的行业之一。现在人们对待健康的态度的转变，人们行动的转变所带来的好处已经开始显露出来了：因心脏病致死的病例下降了，这使人们得到很大的鼓舞。