Preventive healthcare deals with the prevention of illness to decrease the burden of disease and associated risk factors. Preventive measures can be applied at all stages across the lifespan and along a disease spectrum, to prevent further decline over time. This article highlights the various levels of prevention, provides examples of preventive recommendations and discusses some of the debate within the disciplines of the population and public health.
- Levels of Prevention
- Examples of Preventive Recommendations
- Division in Preventive Care
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Chronic diseases are the leading cause of death and disability worldwide and are linked to increasing health costs. Preventative care is advocated as part of a population health approach and includes both clinical preventative services and screening tests. Identifying and preventing potential problems downstream is one strategy for controlling utilization and improving health outcomes.
Levels of Prevention
The primordial level of prevention is a population health approach characterized as the actions that are taken to prevent future hazards to health and to decrease those factors which are known to increase the risks of disease. The broad determinants of health are addressed rather than individual exposure to risk factors. Examples of primordial prevention initiatives include improving sanitation, promoting healthy lifestyles in childhood, and developing green energy approaches.
Primary prevention prevents the onset of chronic disease by reducing risk factors for development. One type of primary prevention is reducing risks through changes in either behaviour or exposure. Examples include reducing cardiovascular risk through lifestyle changes such as healthy eating and not smoking. Another form of primary prevention is to enhance resistance to exposure of disease through vaccinations (e.g., influenza and pneumonia vaccines, along with childhood vaccines). Some of these prevention techniques can be active involving individual participation and others are passive. Primary prevention generally has a focus on specific risk factors for certain diseases.
Secondary prevention involves the detection and treatment of pre-clinical changes. Screening procedures are often the first step, leading to early and more cost-effective interventions. The screening process is the combined responsibility of the individual and their healthcare providers, with an emphasis on patient engagement.
Tertiary prevention that focuses on reversing, arresting or delaying disease is solely in the clinical realm. It helps to lessen the impact of disease on the patient’s overall life. The patient has more contact with the healthcare system, and care providers in many roles and settings.
The figure below is an example of levels of prevention for osteoporosis:4
Examples of Preventive Recommendations
There are a number of good sources for evidence-based recommendations that can be accessed by healthcare providers around the world. Examples include the U.S. Preventive Services Task Force, the Canadian Task Force on Preventive Care (CTFPC) which are independent groups of experts that seek to make recommendations on preventive care, including screenings, based on available evidence. Examples of relevant references include the CTFPC's Red Book which includes recommendations for screening and prevention throughout the lifespan. A recent campaign called Choosing Wisely has a number of excellent resources including a Starter Kit and a searchable site with lists of commonly used tests where there is insufficient evidence to warrant their use and/or they could cause unnecessary harm to patients.
Division in Preventive Care
Prevention is the deterring of the development of a disease, or stopping the progression of a disease that has already begun. The separation of the roles of public health and medicine in the spectrum of disease prevention and treatment creates a lack of coordination in preventive care. For example, those in public health may view populations as all residents in a geographic area, whereas clinicians may view populations as only those that they have delivered care to, which blurs the line between the risk for disease and the disease itself, as well as between prevention and treatment.
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- Population Health: An Implementation Guide to Improve Outcomes and Lower Costs
- The Stages of Prevention
- Health promotion and disease prevention through population-based interventions, including action to address social determinants and health inequity
- Primary Prevention of Osteoporosis: Time to Redefine the Wheel?