Preventive healthcare consists of measures taken that focus on disease prevention, as opposed to disease treatment. Preventive medicine encompasses efforts on the part of the individual to improve and maintain their own good health, services provided by healthcare providers, and community and public health campaigns made by the government and other organizations. Each year, millions of people die preventable deaths. A study by Mokdad, Marks, Stroup, and Gerberding (2004) showed that about half of all deaths in the United States in 2000 were due to preventable behaviors and exposures. Leading causes included cardiovascular disease, chronic respiratory disease, unintentional injuries, diabetes, and certain infectious diseases. This same study estimates that 400,000 people die each year in the United States due to poor diet and a sedentary lifestyle. According to estimates made by the World Health Organization (WHO), about 55 million people died worldwide in 2011, two thirds of this group from non-communicable diseases, including cancer, diabetes, and chronic cardiovascular and lung diseases. This is an increase from the year 2000, during which 60% of deaths were attributed to these diseases. Preventive healthcare is especially important given the worldwide rise in prevalence of chronic diseases and deaths from these diseases.
- 1 Categories
- 2 Leading cause of preventable death
- 3 Healthcare Professionals
- 4 Methods and Programs of Prevention
- 5 Effectiveness
- 6 See also
- 7 References
- 8 External links
Levels of Prevention
Preventive healthcare strategies are typically described as taking place at the primary, secondary, and tertiary prevention levels. In the 1940's, Hugh Leavell and E. Guerney Clark coined the term primary prevention. They worked at the Harvard and Columbia University Schools of Public Health, respectively, and later expanded the levels to include secondary and tertiary prevention. Goldston (1987) notes that these levels might be better described as "prevention, treatment, and rehabilitation" though the terms primary, secondary, and tertiary prevention are still commonly in use today.
Primary prevention consists of health promotion and specific protection. Health promotion activities are non-clinical life choices, for example, daily exercise, that both prevent disease and create a sense of overall well-being. On the other hand, specific protection targets a type of disease or injury, for example, wearing seat-belts to prevent automobile-related injuries, and also complements the goals of health promotion. Secondary prevention deals with latent diseases and attempts to prevent asymptomatic disease from progressing to symptomatic disease. Certain diseases can be classified as primary or secondary, depending on definitions of what constitutes a disease, but in general, primary prevention addresses the root cause of a disease or injury whereas secondary prevention aims to detect and treat a disease early on. Finally, tertiary prevention attempts to reduce the damage caused by symptomatic disease. Goals of tertiary prevention include: preventing pain and damage, halting progression and complications from disease, and restoring the health and functions of the individuals affected by disease.
|Primary prevention||Methods to avoid occurrence of disease either through eliminating disease agents or increasing resistance to disease. Examples include immunization against disease, maintaining a healthy diet and exercise regimen, and avoiding smoking.|
|Secondary prevention||Methods to detect and address an existing disease prior to the appearance of symptoms. Examples include treatment of hypertension (a risk factor for many cardiovascular diseases), cancer screenings |
|Tertiary prevention||Methods to reduce negative impact of symptomatic disease, such as disability or death, through rehabilitation and treatment. Examples include surgical procedures that halt the spread or progression of disease |
Universal, selective, and indicated
Gordon (1987) in the area of disease prevention, and later Kumpfer and Baxley in the area of substance use proposed a three-tiered preventive intervention classification system: universal, selective, and indicated prevention. Amongst others, this typology has gained favor and is used by the U.S. Institute of Medicine, the NIDA and the European Monitoring Centre for Drugs and Drug Addiction.
|Universal prevention||Involves whole population (nation, local community, school, district) and aims to prevent or delay the abuse of alcohol, tobacco, and other drugs. All individuals, without screening, are provided with information and skills needed to prevent the problem.|
|Selective prevention||Involves groups whose risk of developing problems of alcohol abuse or dependence is above average. Subgroups may be distinguished by traits such as age, gender, family history, or economic status. For example, drug campaigns in recreational settings.|
|Indicated prevention||Involves a screening process, and aims to identify individuals who exhibit early signs of substance abuse and other problem behaviours. Identifiers may include falling grades among students, known problem consumption or conduct disorders, alienation from parents, school, and positive peer groups etc.|
Outside the scope of this three-tier model is environmental prevention. Environmental prevention approaches are typically managed at the regulatory or community level and focus on ways to deter drug consumption. Prohibition and bans (e.g. on smoking, alcohol advertising) may be viewed as the ultimate environmental restriction. However, in practice, environmental preventions programs embrace various initiatives at the macro and micro level, from government monopolies for alcohol sales through roadside sobriety or drug tests, worker/pupil/student drug testing, increased policing in sensitive settings (near schools, at rock festivals), and legislative guidelines aimed at precipitating punishments (warnings, penalties, fines).
Leading cause of preventable death
|Cause||Deaths caused||% of all deaths|
|Poor diet and physical inactivity||400,000||16.6|
|Sexually transmitted infections||20,000||0.8|
|Cause||Deaths caused (millions per year)|
|Sexually transmitted infections||3.0|
|Overweight and obesity||2.5|
|Indoor air pollution from solid fuels||1.8|
|Unsafe water and poor sanitation||1.6|
In the United States, preventive medicine is a medical specialty, and has one of the 24 certifying boards recognized by the American Board of Medical Specialties (ABMS). It encompasses three areas of specialization:
- General preventive medicine and public health
- Aerospace medicine
- Occupational medicine
Advanced practice registered nurse specialities incorporate preventative healthcare into their education and training programs. In addition, public health nursing and occupational health nursing traditionally focuses on preventative healthcare.
Methods and Programs of Prevention
|Intervention||Percent of all child deaths preventable|
|Water, sanitation, hygiene||3|
|Newborn temperature management||2|
|Nevirapine and replacement feeding||2|
|Antibiotics for premature rupture of membranes||1|
|Antimalarial intermittent preventive treatment in pregnancy||<1%|
Some specific examples of prophylaxis include:
- Many vaccines are prophylactic, vaccines such as polio vaccine, smallpox vaccine, measles vaccine, mumps vaccine and others have greatly reduced many childhood diseases; HPV vaccines prevent certain cancers; influenza vaccine.
- Birth control methods are used to prevent unwanted pregnancy. Condoms, for instance, are sometimes euphemistically referred to as "prophylactics" because of their use to prevent pregnancy, as well as the transmission of sexually transmitted infections.
- Daily and moderate physical exercise in various forms can be called prophylactic because it can maintain or improve one's health. Cycling for transport appears to very significantly improve health by reducing risk of heart diseases, various cancers, muscular- and skeletal diseases, and overall mortality.
- Eating plenty of fruits and vegetables each day may be prophylactic. It may reduce the risk of heart disease.
- Fluoride therapy and tooth cleaning, either at home or by a professional, are parts of dental prophylaxis or oral prophylaxis.
- Antibiotics are sometimes used prophylactically: For example, during the 2001 anthrax attacks scare in the United States, patients believed to be exposed were given ciprofloxacin. In similar manner, the use of antibiotic ointments on burns and other wounds is prophylactic. Antibiotics are also given prophylactically just before some medical procedures such as pacemaker insertion.
- Tricyclic antidepressants (TCAs) may, with caution, be an example of a chronic migraine preventive (see amitriptyline and migraines' prevention by medicine).
- Antimalarials such as chloroquine and mefloquine are used both in treatment and as prophylaxis by visitors to countries where malaria is endemic to prevent the development of the parasitic Plasmodium, which cause malaria.
- Mechanical measures (such as graduated compression stockings or intermittent pneumatic compression) and drugs (such as low-molecular-weight heparin, unfractionated heparin, and fondaparinux) may be used in immobilized hospital patients at risk of venous thromboembolism.
- Risk reducing or prophylactic mastectomies may be carried out for carriers of the BRCA mutation gene to minimise the risk of developing breast cancer.
- Early and exclusive breastfeeding provides immunological protection against infectious diseases and well as reduced risk of chronic diseases for both mother and child.
- Polypill for prevention of e.g. cardiovascular disease.
- Potassium iodide is used prophylactically to protect the thyroid gland from absorbing inhaled or ingested radioactive iodine, which may lead to the development of thyroid cancer; radioactive iodine may be released into the environment in the event of an accident at a nuclear power plant, or the detonation of a nuclear explosive (see thyroid protection due to nuclear accidents and emergencies).
- Prophylaxis may be administered as oral medication. Oral prophylaxis includes: PEP, nPEP, or PrEP. PEP stands for post-exposure prophylaxis used in an occupational setting e.g., to prevent the spread of HIV or Hepatitis C from patient to staff following an accidental needlestick. nPEP is non-occupational post-exposure prophylaxis. nPEP may be used in a sexual or injection exposure to HIV, hepatitis, or other infectious agents; for example, during intercourse, if the condom breaks and one partner is HIV-positive, nPEP will help to decrease the probability that the HIV-negative partner becomes infected with HIV. (An nPEP is sometimes known as a PEPse - i.e. post-exposure prophylaxis sexual encounter.) PrEP is a measure taken daily (before, during, and after) possible exposure; for example, by a person who inconsistently uses condoms during sex with a partner who may have an HIV infection.
- Exercise is a key element in the prevention of inflammatory diseases in particular. Developing research has demonstrated that many of the benefits of exercise are mediated through the role of skeletal muscle as an endocrine organ. That is, contracting muscles release multiple substances known as myokines which promote the growth of new tissue, tissue repair, and various anti-inflammatory functions, which in turn reduce the risk of developing various inflammatory diseases.
There is no general consensus as to whether or not preventive healthcare measures are cost-effective and worth long-term investment. There are varying views on what constitutes a "good investment." Some argue that preventive health measures should save more money than they cost, when factoring in treatment costs in the absence of such measures. Others argue in favor of "good value" or conferring significant health benefits even if the measures do not save money Furthermore, preventive health services are often described as one entity though they comprise a myriad of different services, each of which can individually lead to net costs, savings, or neither. Greater differentiation of these services is necessary to fully understand both the financial and health impacts.
A 2010 study showed that in the United States, vaccinating children, cessation of smoking, daily prophylactic use of aspirin, and Screening of breast and colorectal cancers had the most potential to prevent premature death. Preventive health measures that resulted in savings included vaccinating children and adults, smoking cessation, daily use of aspirin, and screening for issues with alcoholism, obesity, and vision failure. These authors estimated that if usage of these services in the United States increased to 90% of the population, there would be net savings of $3.7 billion, which comprised only about -0.2% of the total 2006 United States healthcare expenditure.
While these specific services bring about small net savings not every preventive health measure saves more than it costs. Cohen et al. (2008) outline a few arguments made by skeptics of preventive healthcare. Many argue that preventive measures only cost less than future treatment when the proportion of the population that would become ill in the absence of prevention is fairly large. The Diabetes Prevention Program Research Group conducted a 2012 study evaluating the costs and benefits (in quality-adjusted life-years or QALY's) of lifestyle changes versus taking the drug metformin. They found that neither method brought about financial savings, but were cost-effective nonetheless because they brought about an increase in QALY's. In addition to scrutinizing costs, preventive healthcare skeptics also examine efficiency of interventions. They argue that while many treatments of existing diseases involve use of advanced equipment and technology, in some cases, this is a more efficient use of resources than attempts to prevent the disease. Cohen et al. (2008) suggest that the preventive measures most worth exploring and investing in are those that could benefit a large portion of the population to bring about cumulative and widespread health benefits at a reasonable cost.
- American Board of Preventive Medicine
- American Osteopathic Board of Preventive Medicine
- Centers for Disease Control and Prevention
- Mental illness prevention
- Monitoring (medicine)
- Pre-exposure prophylaxis
- Preventive Medicine (journal)
- Prophylactic rule
- Katz, D., & Ather, A. (2009). Preventive Medicine, Integrative Medicine & The Health of The Public. Commissioned for the IOM Summit on Integrative Medicine and the Health of the Public. Retrieved from http://www.iom.edu/~/media/Files/Activity%20Files/Quality/IntegrativeMed/Preventive%20Medicine%20Integrative%20Medicine%20and%20the%20Health%20of%20the%20Public.pdf
- Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual Causes of Death in the United States, 2000. Journal of the American Medical Association,291(10), 1238-1245.
- The Top 10 Causes of Death. (n.d.). Retrieved March 16, 2014, from World Health Organization website: http://www.who.int/mediacentre/factsheets/fs310/en/index2.html
- Goldston, S. E. (Ed.). (1987). Concepts of primary prevention: A framework for program development. Sacramento: California Department of Mental Health
- Module 13: Levels of Disease Prevention. (2007, April 24). Retrieved March 16, 2014, from Centers for Disease Control and Prevention website: http://www.cdc.gov/excite/skincancer/mod13.htm
- Patterson, C., & Chambers, L. W. (1995). Preventive health care. The Lancet, 345, 1611-1615.
- Gordon, R. (1987), ‘An operational classification of disease prevention’, in Steinberg, J. A. and Silverman, M. M. (eds.), Preventing Mental Disorders, Rock-ville, MD: U.S. Department of Health and Human Services, 1987.
- Kumpfer, K. L., and Baxley, G. B. (1997), 'Drug abuse prevention: What works?', National Institute on Drug Abuse, Rock-ville.
- Mokdad AH, Marks JS, Stroup DF, Gerberding JL (March 2004). "Actual causes of death in the United States, 2000". JAMA 291 (10): 1238–45. doi:10.1001/jama.291.10.1238. PMID 15010446.
- Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ (May 2006). "Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data". Lancet 367 (9524): 1747–57. doi:10.1016/S0140-6736(06)68770-9. PMID 16731270.
- Specialties and Subspecialties. (2006-2012). Retrieved March 16, 2014, from American Board of Medical Specialties website: https://www.abms.org/who_we_help/physicians/specialties.aspx
- Jones G, Steketee R, Black R, Bhutta Z, Morris S, and the Bellagio Child Survival Study Group* (5 July 2003, 2003). "How many child deaths can we prevent this year?". Lancet 362 (9524): 1747–57.
- Jamie Michelle Womack (2010) "Safety and adherence: Issues that hinder childhood vaccinations" Journal of the American Academy of Physician Assistants
- Lars Bo Andersen et al. (June 2000). "All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work". Archives of Internal Medicine 160 (11): 1621–8. doi:10.1001/archinte.160.11.1621. PMID 10847255.
- United States Department of Agriculture. "Why is it important to eat fruit?". United States Department of Agriculture. Retrieved 8 February 2012.
- "Recommendations for using fluoride to prevent and control dental caries in the United States. Centers for Disease Control and Prevention". MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control 50 (RR-14): 1–42. 2001. PMID 11521913.
- Creeth, J. E.; Gallagher, A.; Sowinski, J.; Bowman, J.; Barrett, K.; Lowe, S.; Patel, K.; Bosma, M. L. (2009). "The effect of brushing time and dentifrice on dental plaque removal in vivo". Journal of dental hygiene : JDH / American Dental Hygienists' Association 83 (3): 111–116. PMID 19723429.
- de Oliveira JC, Martinelli M, D'Orio Nishioka SA, et al. (2009). "Efficacy of antibiotic prophylaxis prior to the implantation of pacemakers and cardioverter-defibrillators: Results of a large, prospective, randomized, double-blinded, placebo-controlled trial". Circulation: Arrhythmia and Electrophysiology 2 (1): 29–34. doi:10.1161/CIRCEP.108.795906. PMID 19808441.
- Qaseem A, Chou R, Humphrey LL, et al. (2011). "Venous Thromboembolism Prophylaxis in Hospitalized Patients: A Clinical Practice Guideline From the American College of Physicians". Annals of Internal Medicine 155 (9): 625–632. doi:10.1059/0003-4819-155-9-201111010-00011. PMID 22041951.
- Lederle FA, Zylla D, MacDonald R, et al. (2011). "Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients and Those With Stroke: A Background Review for an American College of Physicians Clinical Practice Guideline". Annals of Internal Medicine 155 (9): 602–615. doi:10.1059/0003-4819-155-9-201111010-00008. PMID 22041949.
- Kahn SR, Lim W, Dunn AS, et al. (February 2012). "Prevention of VTE in Nonsurgical Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest 141 (2 suppl): e195S–e226S. doi:10.1378/chest.11-2296. PMC 3278052. PMID 22315261.
- Ip S, Chung M, Raman G, ChewP, Magula N, DeVine D, Litt M, Trikalinos T, Lau J. Breastfeeding and maternal and infant health outcomes in developed countries. Evidence Report/Technology Assessment Number 153. 2007 April; AHRQ Publication No. 07-E007.
- Muscle as a secretory organ. Pedersen BK. American Physiological Society. Compr Physiol 3:1337-1362, 2013. http://www.inflammation-metabolism.dk/index.php?pageid=21&pmid=23897689
- Michael V. Maciosek, Ashley B. Coffield, Thomas J. Flottemesch, Nichol M. Edwards and Leif I. Solberg. Greater Use Of Preventive Services In U.S. Health Care Could Save Lives At Little Or No Cost. Health Affairs, 29, no.9 (2010):1656-1660. doi: 10.1377/hlthaff.2008.0701.
- Cohen, J. T., Neumann, P. J., & Weinstein, M. C. (2008, February 14). Does Preventive Care Save Money? Health Economics and the Presidential Candidates. The New England Journal of Medicine, 358(7), 661-663.
- The Diabetes Prevention Program Research Group (2012). The 10-Year Cost-Effectiveness of Lifestyle Intervention or Metformin for Diabetes Prevention. Diabetes Care, 35, 723-730.
- US Preventive Medicine Task Force
- US Preventive Medicine
- The Prevention Plan
- Health-EU Portal Prevention and Promotion