Rehabilitation : the health strategy of the 21 st century 313 in addressing the challenges of injuries caused by war and violence , providing new approaches to combating infectious diseases through antibiotics , and targeted molecular therapies for cancer and autoimmune diseases . As the curative and preventive strategies joined forces towards the end of the 19 th century and the beginning of the 20 th century , and the causes of diseases , stunting , and other threats to health became better understood , many of the common lethal diseases become more controllable ( 25 ) and , for example , HIV-AIDS , lupus and breast cancer were transformed into chronic health conditions . During this time much of the focus of prevention shifted to individual lifestyle and behaviour , and toward the end of the 20 th century , shifted again to address broader social determinants ( 27 , 28 ). These changes ( socioeconomic improvement , an increase in scientific and technological progress , and a broader understanding of prevention ) were the major drivers of improvements in health , resulting in the current life expectancy of 75 – 85 years in the most developed countries ( 29 – 30 ).
As a public health strategy , health promotion was very much a product of the 20 th century as it arose out of the optimism from the previous successes of cure and prevention and a renewed awareness of the responsibilities of the high-income countries toward the health of the rest of the world ( 31 ). Whether this optimism is justified remains to be seen , especially in light of public health disasters , such as the obesity epidemic in the USA , fostered by industry-influenced academic and governmental recommendations ( 32 ).
Which of these traditional health strategies should we turn to in order to meet the challenges of the 21 st century and beyond ? Certainly the curative health strategy is not , at least at present , a realistic solution for most of the high-burden NCDs , or for that matter age-specific problems , such as geriatric syndromes and frailty . On the other hand , according to the WHO , a large percentage of NCDs are preventable through a reduction in the major behavioural risk factors of tobacco use , physical inactivity , harmful use of alcohol and unhealthy diet ( 8 , 9 ). Whatever our successes in the future in this regard , however , short of genetic modification , NCDs will continue to dominate population health . Ageing , of course , is inevitable and older people are more likely to have multiple , coexistent , and interrelated health problems . This fact , together with geriatric syndromes , frailty and impaired cognition , continence , gait , and balance , suggests the need for a more thorough “ retooling ” of the healthcare system and workforce to meet the health challenge of ageing ( 33 , 34 ).
Taking ageing and the epidemic of NCD together , in other words , strongly suggests that health policy should aim not merely at expanding NCD prevention programmes but also scaling up that health strategy whose explicit objective is to optimize the levels of functioning experienced by people across the lifespan ; namely rehabilitation .
THE CHARACTER OF REHABILITATION AND THE REHABILITATION STRATEGY
Although a comprehensive history of rehabilitation has yet to be written , it is clear that the origins and evolution of rehabilitation science and practice , at least in the USA and Europe , are closely linked to the needs of veterans with permanent injuries returning from wars . For example , armour makers of the medieval era were skilled in making functionally effective hand and leg prostheses for returning soldiers ( 35 ). In the UK and the USA in particular , addressing the needs of injured veterans was a principal driver of the developing practice of rehabilitation specialties ( 36 , 37 ).
The moral force of assisting soldiers who fought for their country and needed to return to their previous life and employment was very powerful . It was an easy argument to make that society owed its soldiers its assistance , and for this reason , for example in the USA , the earliest legislative recognition of the needs of disabled veterans and the value of rehabilitation services were addressed to veterans ( 39 ). In the USA , soon after the First World War , specialties of physical and speech therapy and orthotics and prosthetics began to serve the parallel needs of persons injured at work or otherwise RES limited in mobility , sensory or cognitive capacity . The rise in rehabilitation professionalization linked with developing specialties such as orthopaedic surgery and “ physiatry ” or physical medicine in the late 1930s . Research in the emerging science of rehabilitation and engineering expanded after the Second World War , initially to serve the needs of veteran amputees , but later for the civilian population too ( 40 , 41 ).
In many European countries , including Switzerland and Germany , rehabilitation had its roots primarily in , or in parallel with , the century-long tradition of physical modalities and health resort or spa treatments with their holistic approach to physical and mental health . That is why the Germany-based Journal of Physical and Rehabilitation Medicine still carries the name “ Kurortmedizin ” ( health resort medicine ) in German . These approaches aimed to improve body functions and activities as well as quality of life and participation and were
J Rehabil Med 50 , 2018