Iceberg

1. Iceberg of DiseaseIceberg of Disease
Concepts of control andConcepts of control and
Levels of PreventionLevels of Prevention
Dr. Jai Kershan, MD, MSPHDr. Jai Kershan, MD, MSPH
(USA)(USA)
http://jaikershan.blogspot.comhttp://jaikershan.blogspot.com

2. We will learn in this presentationWe will learn in this presentation
 Concepts of iceberg of diseaseConcepts of iceberg of disease
 Concepts of disease controlConcepts of disease control
 Concepts of prevention, likeConcepts of prevention, like
• Primary, secondary & tertiary preventionPrimary, secondary & tertiary prevention

3. Iceberg of DiseaseIceberg of Disease

4. continuecontinue
 The floating tip of ice bergThe floating tip of ice berg
represents clinical casesrepresents clinical cases
 Submerge portion showsSubmerge portion shows
undiagnosed cases or hidden mass ofundiagnosed cases or hidden mass of
diseasedisease
 Undiagnosed reservoir of disease is aUndiagnosed reservoir of disease is a
challenge to modern techniques inchallenge to modern techniques in
preventive medicinepreventive medicine

5. Disease controlDisease control
 Aimed at reducingAimed at reducing
• Incidence of diseaseIncidence of disease
• Duration of diseaseDuration of disease
• Physical and psychological complicationsPhysical and psychological complications
• Reducing financial burden of communityReducing financial burden of community
 Activities consist of primaryActivities consist of primary
preventionprevention
 Can be secondary preventionCan be secondary prevention

6. Primordial preventionPrimordial prevention
 This is special in the sense ofThis is special in the sense of
preventing chronic diseases likepreventing chronic diseases like
• obesity and hypertensionobesity and hypertension
 Prevention of risk factors inPrevention of risk factors in
population which have yet notpopulation which have yet not
appearedappeared
 Smoking, eating patterns, exerciseSmoking, eating patterns, exercise
 Main intervention is mass educationMain intervention is mass education

7. Primary preventionPrimary prevention
 Defined as action taken prior toDefined as action taken prior to
onset of diseaseonset of disease
 Intervention in prepathogensis ofIntervention in prepathogensis of
diseasedisease
 WHO recommended two approachesWHO recommended two approaches
 Population strategyPopulation strategy
 High risk strategyHigh risk strategy

8. Population strategyPopulation strategy
 Directed at whole populationDirected at whole population
 Education of exerciseEducation of exercise
 Lowers serum cholesterolLowers serum cholesterol
 Lowers risk of cardiovascular diseasesLowers risk of cardiovascular diseases
 High risk strategyHigh risk strategy
 Preventive care to people at special riskPreventive care to people at special risk
 Safety and lower cost justifies its widerSafety and lower cost justifies its wider
applicationapplication

9. Secondary preventionSecondary prevention
 Action taken at incipient stage ofAction taken at incipient stage of
diseasedisease
 Specific interventions areSpecific interventions are
• ScreeningScreening
• Case finding programsCase finding programs
• more expensive and less effective thanmore expensive and less effective than
primary preventionprimary prevention
 Draw back is patient feels pain &Draw back is patient feels pain &
productivityproductivity

10. Tertiary preventionTertiary prevention
 When disease is advanced beyond itsWhen disease is advanced beyond its
early stagesearly stages
• All measures available to reduce painAll measures available to reduce pain
and diseasesand diseases
• When disability stabilized then applyWhen disability stabilized then apply
rehabilitationrehabilitation
• Consist of psychosocial, vocational andConsist of psychosocial, vocational and
medical componentsmedical components