Levels of Prevention

“Prevention is the action aimed at eradicating, eliminating or minimizing the impact of disease and disability.”
–John M Last .

Level of prevention are classified into 4 stages

• Primordial prevention
• Primary prevention
• Secondary prevention
• Tertiary preventing

Primordial prevention is defined as prevention of risk factors themselves, beginning with change in social and environmental conditions in which these factors are observed to develop, and continuing for high risk children, adolescents and young adults.

It is the prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared.

Primordial prevention, a relatively new concept, is receiving special attention in the prevention of chronic diseases.

For example, many adult health problems (e.g. obesity, hypertension) have their early origins in childhood, because this is the time when lifestyles are formed (for example, smoking, eating patterns, physical exercise).

Primordial prevention begins in childhood when health risk behavior begins. Parents, teachers and peer groups are important in imparting health education to children.

The main intervention in primordial prevention is through individual and mass education

Examples of primordial prevention

• National policies and programmes on nutrition involving the agricultural sector, the food industry, and the food import-export sector
• Comprehensive policies to discourage smoking
• Programes to promote regular physical activity
• Making major changes in lifestyle

Primary prevention can be defined as the action taken prior to the onset of disease, which removes the possibility that the disease will ever occur.

It signifies intervention in the prepathogenesis phase of a disease or health problem.

Primary prevention may be accomplished by measures of

1. Health promotion
2. Specific protection

Health Promotion

It is the process of enabling people to increase control over the determinants of health and thereby improve their health.

Health Promotion is directed towards strengthening the Host.

Main aims of health promotion is to enable people to increase control over health & to improve the overall health.

The Aim can be achieved by the following Intervention:

• Health Education
• Environmental Modification
• Behavioral Changes
• Life Style change
• Nutritional Intervention

Health education to improve healthy habits and health consciousness in the community.

Improvement in nutritional standards of the community.

Healthful physical environment (Housing, water supply, excreta disposal etc.

Good working condition

Periodic Selective examination of risk population.

Specific Protection

Efforts directed toward protection against specific diseases.

The provision of conditions for normal mental & physical functioning of the human beings & in group.

It includes the promotion of health, prevention of sickness, & care of individuals

Aims of Specific Protection

• Intervention
• Immunization
• Use of specific nutrients
• Chemoprophylaxis
• Protection against occupational hazards
• Protection against accidents
• Control of general environment
• Avoidance of allergens etc.

Specific Protection includes-

• Use of Specific immunization (BCG, DPT, MMR vaccines)
• Chemoprophylaxis (tetracycline for cholera, dapsone for leprosy, chloroquine for malaria, etc.
• Use of specific nutrients (vitamin A for Children, iron and folic acid tablets for pregnant mothers)
• Protection against accidents (Use of helmet, seatbelt, etc.
• Protection against occupational hazards. • Avoidance of allergens.
• Protection from air pollution

It is defined as “An Action which halts the progress of a disease at its incipient stage and prevents complications.”

The specific interventions are:

• Early diagnosis (e.g. screening tests, case findings, breast self-examination, pap smear test, radiographic examinations etc.
• Adequate Treatment
• Referral

Secondary prevention attempts to arrest the disease process, restore health by seeking out unrecognized disease and treating it before irreversible pathological changes take place, and reverse communicability of infectious diseases.

It protects others in the community from acquiring the infection and thus provide at once secondary prevention for the infected ones and primary prevention for their potential contacts.

Objectives of Secondary Prevention

• Complete cure and prevent the progression of disease process.
• To prevent the spreads of disease by curing all the known cases.
• To prevent the complications and sequel of disease.
• To shorten the period of disability.

The disease complications can be prevented and health can be restored by diagnosing the disease at its early stages and by providing the adequate treatment according to the health problem.

Includes—

• Arrests/stops the disease process.
• Restore the health.
• Treat the disease before irreversible pathological changes occur.
• Reverse the communicability of infectious disease.
• Screening surveys (urine examination for diabetes)

Mass Treatment Approach includes:

• Juvenile Mass Treatment
• Selective Mass Treatment
• Total Mass Treatment
The type of approach used depends upon the nature of the disease and incidence of disease.

It is used when the disease process has advanced beyond its early stages.

It is defined as “all the measures available to reduce or limit impairments and disabilities, and to promote the patients’ adjustment to irremediable conditions.”

Intervention that should be accomplished in the stage of tertiary prevention are

1. Disability limitation, and
2. Rehabilitation.

Disability limitation

Disease→ Impairment→ Disability→ Handicap

Disease— diseases are often known to be medical conditions that are associated with specific symptoms and signs.

Impairment— any loss or abnormality of physiological, psychological, or anatomical structure or function.

Disability— any restriction or lack of ability to perform an ability in normal range of human being.

Handicap— permanent disability or impairment of an individual.

Rehabilitation

Rehabilitation is “the combined and coordinated use of medical, social, educational, and vocational measures for training and retraining the individual to the highest possible level of functional ability.”

Requires cooperation from different sections of society.

Types of Rehabilitation

• Medical rehabilitation: restoration of bodily function.
• Vocational rehabilitation: restoration of the capacity to earn a livelihood
• Social rehabilitation: restoration of family and social relationship.
• Psychological rehabilitation: Restoration of personal dignity and confidence.

Examples of Rehabilitation

• Establishing schools for the blind.
• Exercises in neurological disorders
• Prosthetic restoration of lost tooth
• Reconstructive surgery in Leprosy.

What is Public Health Surveillance?

The ongoing, systematic collection, analysis, and interpretation of health data, essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination to those who need to know

Surveillance provides the information for descriptive epidemiology, which is

• Person (age, sex, description)
• Place (where)
• Time (dates, hours, days, months, years)

Who Performs Public Health Surveillance?

• Epidemiologists
• Medical professionals (doctors, nurses, clinics)
• Pharmacies
• Health insurance providers
• Emergency responders
• Public health departments (local, state, federal)

Why Do We Use Public Health Surveillance?

Because it can

• Estimate the size of a health problem
• Determine where an illness is occurring geographically
• Portray the natural history of a disease
• Detect epidemics or define a problem
• Generate hypotheses in research
• Monitor changes in infectious agents
• Detect changes in health practices
• Facilitate emergency planning

Where Do We Get Public Health Surveillance Data?

Vital records

• Hospital records, death certificates, birth records

Surveys

• Schools, doctors, insurance companies

Environmental monitoring systems

• Water or air quality

Animal health data

• Veterinarians, farms, food manufacturing

How Are Public Health Surveillance Data Collected?

Voluntary reporting

• Individual persons reporting (a person, doctor, or hospital)
• Media reports
• Unusual health occurrences
• Higher purchases of specific pharmaceuticals; excessive school absences

Public health initiated surveys

• Calling, completing forms, reviewing public records

Mandatory reporting

• Some diseases are required to be reported to the local and state health departments (reportable diseases).
• Highly communicable (transmittable) diseases
• E.g., chickenpox
• High morbidity or mortality rates
• E.g., Ebola virus disease
• Strong public interest
• E.g., methicillin-resistant Staphylococcus aureus (often referred to as MRSA)

Public Health Surveillance Types

Different ways of collecting surveillance data fall into 3 categories

• Passive
• Active
• Syndromic

Passive Surveillance

Laboratories, physicians, or others regularly report cases of disease or death to the local or state health department

Examples

• A doctor’s office reports 2 cases of measles
• A nursing home reports an unusual number of older patients with unexplained rashes

Active Surveillance

Local or state health departments initiate the collection of information from laboratories, physicians, health care providers, or the general population

Achieves more complete and accurate reporting than passive surveillance

Example: Youth Risk Behavior Surveillance surveys

Syndromic Surveillance

The ongoing, systematic collection, analysis, interpretation, and application of real-time indicators for disease that allow for detection before public health authorities might otherwise identify them

Example: Hospital admittance records

Purposes of Public Health Surveillance

Surveillance has been used for the following types of outbreaks:

• Food poisoning
• Cancer clusters
• Health threats after natural or human-made disasters
• Cholera in Haiti after the 2010 earthquake
• Air quality after the September 11, 2001, attacks

Infectious disease outbreaks

• Ebola
• Malaria
• Influenza
• Severe acute respiratory syndrome (SARS)
• Chronic health problems
• Obesity
• Cardiovascular diseases
• Asthma