Levels of Prevention

.
 Prevention
• To come Before

• Preventive can be taken at any stage of

actions spectrum
of Health
• Mostly on “Healthy People”

• Goal –to achieve health for all- to lead a productive and

socially useful life
• But it can be applied to unhealthy or sick –to restore
their health at the earliest and
prevent deaths/disability

• It is not necessary to know everything about the

natural history of a disease to initiate
preventive measure

• Often removal or elimination of a single known

essential cause may be sufficient to prevent a
disease
 Scope of prevention
• Reduction in death rates

• Reduction in deaths from infectious

diseases

• General improvements in standard of

living, nutrition, and sanitation

• Major causes of diseases are preventable

 Levels of Prevention
• Primordial healthy people
• Primary
• Secondary sick people
• Tertiary
 Primordial Prevention
• Aim – To prevent emergence of unhealthy life styles
in population
• Prevention of the emergence or development of risk
factors in the community or population groups
in which they have not yet appeared
• Risk prevention strategies right from the childhood to
develop healthy lifestyle
• Examples -lifestyle modification – obesity,
smoking, physical exercise, eating patterns
etc.
• Individual and mass education
 Primary Prevention
• 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 pre-pathogenesis
phase of a disease or health problem
• To limit the incidence of disease by controlling causes
and risk factors
• Elimination or modification of risk factors of disease
 Strategies :
• Health promotion-healthy practices
• Adequate nutrition
• Safe water and sanitation
• Periodic health checkups
• Specific prevention/protection
against disease/trauma/accidents
 Specific protection
• Immunization
• Mega doses of Vit A, IFA tablets
• Salt iodization
• Chemoprophylaxis
• Environmental protection
• Contraception
• Accidents prevention-safety belts & Helmets
 Population (mass) strategy
• Intention to cover whole population irrespective
of individual risk levels
• High impact on reduction of incidence of disease
• Do not require any screening to identify high
risk group
• The population approach is directed
towards socio-economic, behavioral and lifestyle
changes
 High risk Approach
• The high -risk strategy aims to bring preventive care
to individuals at special risk
• Identify specific factors/characteristics that put them
in high risk group
• Try to modify these risk factors
• Preventive – Screening for early
case detection-interventions
• Examples: Smokers, Commercial sex workers,
STD clinic attendees
• Family H/o DM, HT, CHD
 Secondary Prevention
• It is defined as “ 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, and case finding program)
and adequate treatment

• More expensive and less effective than primary

prevention
• 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 thus protects others from 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
 Early detection
• Screening programme
• Vision-refractory errors, cataract
• Blood pressure measurement
 Tertiary Prevention

• Last level of prevention

• To reduce the progress & development of
complications
• Intervention that should be accomplished in the
stage of tertiary prevention are disability
limitation and rehabilitation.
• To prolong life
• To prevent deaths
 Disease

Impairment

Disability

Handicap
 Concept of disability
• Impairment- any loss or abnormality of
psychological, physiological or
anatomical structure or function
• E.g. loss of foot, loss of vision
• One impairment may lead to the development
• Visible or invisible, temporary or
"secondary" impairments as in of
permanent, progressive or regressive
the case ofmay
where damage to nerves (primary impairment) leprosy
lead
to plantar ulcers (secondary impairment).
• Disability- Any restriction or lack of ability to
perform an activity in a manner or within the
range considered normal for a human being.
• Handicap - A disadvantage for a given individual, resulting
from an impairment or disability, that limits or
prevents the fulfillment of a role in the community
that is normal (depending on age, sex, and social
and cultural factors) for that individual

• Example-
• Accident - disease/disorder
• Loss of foot - impairment
• Cannot walk - disability
• Unemployed - handicap
 Rehabilitation
• The combined and coordinated use
medical, social, educational, vocational
of
measures for training, and retraining the
individual to the highest possible level of
functional ability
 Rehabilitation

• Medical- restoration of function

• Vocational-restoration of the capacity to
earn a livelihood
• Social- restoration of family and
social relationships
• Psychological-restoration of personal
dignity and confidence
 Modes of
Intervention
• Any attempt to intervene or interrupt the
usual sequence in the development of disease in
man

• Five modes of interventions

– Health Promotion
– Specific Protection
– Early diagnosis and treatment
– Disability limitation
– Rehabilitation
 1. Health
Promotion
• The process of enabling people to increase control
over and to improve health
• It is not directed against any Particular disease but is
intended to strengthen the host through a variety
of approaches (intervention)
– Health Education
– Environmental modification
– Nutritional intervention
– Lifestyle and behavioral changes
 Health Education
• Most cost effective interventions

• A large number of diseases could be prevented with little

or no medical intervention if people were
adequately informed about them and if they were
encouraged to take necessary precautions in time

• Targets are general public, patients, priority groups,

health providers, community leaders, decision makers
 Environmental
Modifications
• Provision of safe water
• Installation of sanitary latrines
• Control of insects and rodents
• Improvement of housing, etc

• Many infectious diseases have been successfully

controlled in western countries through
environmental modifications, even prior to the
development of specific vaccines or chemotherapeutic
drugs
 Nutritional
Interventions
• Food distribution and nutrition improvement of vulnerable
groups
• Child feeding programmes
• Food fortification
• Nutrition education
 Lifestyle and behavioral
changes
• Balanced diet
• Physical activity
• Cessation of smoking
 2. Specific
Protection
• Immunization
• Use of specific nutrients
• Chemoprophylaxis
• Protection against occupational hazards
• Protection against accidents
• Protection from carcinogens
• Avoidance of allergens
• Control of specific hazards in environment e.g.
Air Pollution, Noise control
• Control of consumer product quality and safety of foods,
drugs, cosmetics, etc
 3. Early Diagnosis and
Treatment
• It is main intervention of disease control
• The earlier a disease is diagnosed and treated the
better it is from the point of view of prognosis
and preventing the occurrence of further
cases (secondary cases) or any long-term disability.
• Important for TB, Leprosy, STD, hypertension, cancer,
diabetes etc.
 4. Disability
Limitation
• When a patient reports late in the pathogenesis phase,
the mode of intervention is disability limitation

• The objective of this intervention is to prevent or halt the

transition of the disease process from impairment
to handicap
 5.
Rehabilitation
• The combined and coordinated use of medical, social,
educational, vocational measures for training,
and retraining the individual to the highest possible
level of functional ability
• It involves disciplines such as
– Physiotherapy
– Occupational therapy
– Speech therapy
– Audiology
– Psychology
– Social work
• Examples
– Establishing schools for the blind
– Provision of aids for the crippled
– Reconstructive surgery in leprosy
– Muscle re-education and graded exercises in
neurological disorders