Disses prevention

1. Prevention & Diseases Control
in Public Health
by Zoha Alharbi

2. 2
Topics
1-Determins of health
2-Definition of Disease Prevention
3-Time line
4-Levels of Prevention
5-concept of disease control

3. Determinants of health??

4. Determinants of health
 The term ‘determinants of health’ was introduced in the 1970s
and it refers to those factors that have a significant influence,
whether positive or negative, on health.
 The term should not imply a cause–effect relationship between a
risk factor and a health status.
 Health is the result of multiple factors including those genetic,
biological, and lifestyle factors relating to the individual and those
factors

5. Determinants of health
In 1998, the WHO established the Commission on the Social
Determinants of Health. The commission recommended policies
and interventions according to ten important topics. These
topics are addiction, early life, food, stress, social exclusion,
social gradient, social support

6. Determinants of health
GENETIC BIOLOGICAL LIFESTYLE
ENVIRONMENTAL SOCIAL

7. 1-Genetic - Factors which determine an individuals predisposition
to disease.
2-Biological – factors in which disease is caused by bacteria or
viruses.
3-Lifestyle – factors in which behaviors contribute to disease. i.e.
smoking, diet, alcohol, tobacco…..
4-Environmental – factors such as geographical, climatic
housing , pollution , noise.

8. Social – factors connected with membership of particular
social groups which may influence other factors. poverty,
income , level of education , cultural environments.
Medical care

9. RISK FACTORS
Alcohol
Obesity
Stress
Smoking
Prolonged sitting
Lifestyle and behavior
Poor nutrition
etc……

10. CHRONIC CONDITION
Chronic disease are the cause of 60% of the deaths in
worldwide . This kills 38 million people
globally every
day. Of the estimated 98.16 lakh deaths in India ( 2014)
TYPE 2DM
CANCERS
HEART DISEASE
ANXIETY
DEPRESSION
MUSCULOSKELETAL DISORDERS etc…
chronic diseases are the cause of half of the deaths in the
world.

12. Diseaseprevention:Definition
Activities designed to protect patients and other members of the
public from actual or potential health threats and their harmful
consequences
-Mosby’s Medical Dictionary, 8th edition.2009

13. Diseaseprevention:Definition
Disease prevention covers measures not only to prevent the
occurrence of disease, such as risk factor reduction, but also to arrest
its progress and reduce its consequences once established.
Reference: adapted from Glossary of Terms used in Health for All
series. WHO, Geneva, 1984

14. 1-Knowledge of causation
2- Dynamics of transmission
3- Identification of risk factors and risk groups
4- Availability of prophylactic or early detection and
treatment measures
6-Facilities for these treatment procedures
7-Evaluation and development of these procedures
Successful Prevention Depends upon:

15. Timeline
1953 – Leavell and Clark
1957 – Commission of chronic illness
1958 – Leavell and Clark
1965 – Leavell and Clark
1983 – Gordon
1985 – Tannahill
2001 – Froom and Benbassat

16. 1953– LeavellandClark
Book: Textbook of preventive medicine
5 levels
of application
Health promotion
Specific protection
Early recognition and prompt treatment
Disability limitation
Rehabilitation
Based on his paper on the disease syphilis

17. 1957– Commisssiononchronicillness
Prevention of chronic illness : Volume 1
First use of the words primary and secondary prevention
Primary prevention: averting the occurrence of disease
Secondary prevention: halting the progression of disease
from its early unrecognized stage to a more severe one and
preventing complications

18. 1958– LeavellandClark
Second edition retitled: Preventive Medicine for the Doctor
and the Community
Defined five levels into three categories
🞑 Primary prevention
Health promotion (serving to further general health and well- being)
Specific protection (measures applicable to a particular disease or group of
diseases in order to intercept the causes before they involve

19. Secondary prevention
🞑 early recognition and prompt treatment (preventing spread to
others if the disease is communicable, complications or sequelae,
and prolonged disability).
Tertiary prevention
🞑 disability limitation (prevention or delaying of the
consequences of clinically advanced disease)
🞑 rehabilitation (aiming at prevention of complete disability
after anatomic and physiologic changes are stabilized).
1958– LeavellandClark

20. 1965– LeavellandClark
Third edition: Preventive Medicine for the Doctor and the
Community
Referred levels of prevention as “phases of prevention” and
Disability limitation was transferred to secondary phase of
prevention

21. 1983- Gordon
Public Health Reports
Limited the use of word prevention to persons who have not
yet suffered and discomfort or disability due to the disease
Classification – target population
🞑 Universal measures : for everyone
🞑 Selective measures : for above-risk demographies
🞑 Indicated measures : for individuals at risk

22. 1985- Tannahill
Reviewed the usages of primary, secondary and tertiary by
different authors, and proposed a new classification
Foci of prevention
Prevention of the first occurrence of an illness or unwanted
phenomenon
Prevention of avoidable consequences of illness or other unwanted state
through early detection when this favorably affects the outcome
Prevention of avoidable complications of established disease or
other unwanted state
Prevention of recurrence.

23. Beyonddiseaseprevention. . .
Breslow proposed in 1999 moving “beyond disease prevention
and aiming for
“the energy and reserves of health that permit a buoyant life,
full of zest the eager ability to meet life’s challenges.”
Thus a supplementary paradigm consisting of four stages of
health promotion/wellness was developed . .

24. Stagesofwellness
🞑 Stage 1: Exposure to positive health influences.
🞑 Stage 2: Adoption of positive health practices (such as healthy
diet, exercise, recreation, adequate sleep, etc.).
🞑 Stage 3: Increase in indicators of health and wellness due to the
healthy practices (such as increased strength and flexibility,
immunity, optimal BMI, etc.).
🞑 Stage 4: Achievement of specific defined health and wellness
goals, both
subjective (e.g., sense of wellbeing and energy, fulfilling social
relationships)
objective measures (e.g., high cognitive function, productivity, capacity
for role fulfillment or achievement)

25. Levelsofprevention
The concepts of prevention can be best defined in the context
of “levels of prevention”.
But how many levels of prevention??

26. LEVELS OF PREVENTION
The concept of prevention is best defined in terms of levels of
prevention. Traditionally,
Primordial prevention
Primary prevention
Secondary prevention
Tertiary prevention
Quaternary prevention

27. Primordialprevention...
Mainly associated with chronic diseases
Intervention – Individual and mass education
Has to start in childhood when health risk behaviour begins

28. Primordialprevention...
Examples of primordial prevention
🞑 National programmes and policies on:
Food and nutrition
Against smoking and drugs
To promote
regular physical activity

29. Primordialprevention...
Responsibility of primordial prevention:
🞑 parents, teachers and peer groups: imparting health
education
🞑 Government: legislating and enacting laws
🞑 Professional and nonprofessional organisations
🞑 Industry
🞑 Hospitals, health practitioners, health care workers

30. PRIMARY PREVENTION
Action taken prior to the onset of disease, which
removes the
possibility that a disease will ever occur
Intervention – prepathogenesis stage of disease
Concept of positive health:
an acceptable level of health that will enable every individual
tolead a socially and economically productive life

31. primaryprevention...
Approaches for primary prevention for chronic diseases
(WHO):
Population (mass) strategy:
Directed at whole population irrespective of individual risk levels
Directed towards socio-economic, behavioral and lifestyle changes
High risk strategy:
To individuals at special risk

32. Populationapproach

Recognises influence of
society

Risk reduction can be
achieved at population
level

Effective in dose-response
relationship of diseases

Less effective in situations
where there is no dose-
response relationship
ADVANTAGES DISADVANTAGES

33. Highriskapproach

Cost effective

Motivation level is higher

Easier for health
professionals to promote
change

Individuals would have
been aware and exposed to
the risk
 Fails toaddress public
health problems which
arise from small risks
 Tends to medicalise
prevention
 Does not focus on what
influences behaviour
 Little overall impact on
control of disease
ADVANTAGES DISADVANTAGES

34. Healthpromotion
Process of enabling people to increase control over and to
improve health
Not directed against any particular disease
Interventions in this area:
🞑 Health education
🞑 Environmental modifications
🞑 Nutritional interventions
🞑 Lifestyle and behavioural changes

35. 
Values in health promotion
🞑 Equity and social justice
🞑 A holistic definition of health
🞑 Covers a full range of health determinants
🞑 Recognizes influence of environment on health
🞑 Seeks to enhance people’s social participation
🞑 Involves intersectoral collaboration (ottawa reference)

36. Specificprotection
Efforts directed toward protection against specific diseases
Interventions
🞑 Immunization
🞑 Use of specific nutrients
🞑 Chemoprophylaxis
🞑 Protection against occupational hazards
🞑 Protection against accidents
🞑 Protection from carcinogens
🞑 Avoidance of allergens etc.

37. SECONDARY PREVENTION
Action which halts the progress of the disease at its incipient
stage and prevents complications
Intervention – early pathogenesis stage
It is the domain of clinical medicine
Drawback
🞑 Patient already subjected to mental anguish & physical pain
🞑 More expensive than primary prevention

38. 
Modes of intervention:
🞑 Early diagnosis (screening tests, case finding programs)
🞑 Adequate/prompt treatment

Effects:
🞑 Seeks out unrecognized disease
🞑 Provides treatment before irreversible changes occur
🞑 Reverses communicability of infectious diseases
🞑 Protects community
secondaryprevention...

39. Earlydiagnosisandprompttreatment
Earlier diagnosed – better prognosis
Reduces morbidity and mortality
Effective in acute conditions

40. TERTIARY PREVENTION
All measures available to reduce or limit impairments and
disabilities, minimize suffering caused by existing departures
from good health and to promote the patients adjustment to
irremediable conditions
Intervention – late pathogenesis stage
Modes of intervention:
🞑 Disability limitation
🞑 Rehabilitation

41. Disabilitylimitation
To prevent or halt the transition of disease process from
impairment to handicap
Disease impairment disability handicap
Impairment: any loss or abnormality of psychological,
physiological or anatomic structure or function
Disability: any restriction or lack of ability to perform an activity
in the manner considered normal for a human being
Handicap: disadvantage for
a given individual, resulting from
impairment or disability, that limits or prevents the fulfillment of a role
that is normal for that individual

42. ACCIDENT Impairment: Loss of an
anatomical structure
Disability: Lack of ability to
perform an activity
Handicap: Prevents
fulfillment of normal role

43. Rehabilitation
The combined and coordinated use of medical, educational,
social and vocational measures for training and retraining the
individual to the highest possible level of functional ability
Types of rehabilitation
🞑 Medical: restoration of function
🞑 Vocational: restoration of capacity to earn a livelihood
🞑 Social: restoration of family and social relationships
🞑 Psychological: restoration of personal dignity and confidence

44. Examples of rehabilitation
🞑 Establishing schools for blind
🞑 Provision of aids for crippled
🞑 Exercises in neurological disorders
🞑 Prosthetic restoration of lost tooth
Requires cooperation from different sections of
society

45. Principlesoftertiaryprevention
TERTIARY
PREVENTION
Enable
timely
recovery
Re-stabilize
Re-train
Re-motivate
Re-socialize
Re-integrate

46. QUATERNARY PREVENTION
The action taken to identify patient at risk of over-medicalisation, to
protect him from new medical invasion, and to suggest to him
interventions, which are ethically acceptable.
Quaternary prevention is the setof health activities tomitigate or avoid the
consequences of unnecessary or excessive intervention of the health
system.

47. Healthcare professionals must beaware of the consequences of their
decisions, and include quaternary prevention interventions in their
daily clinical practice with each patient
Do not mistake risk factor with disease.
To avoid check ups or unnecessary exams.
To avoid technical interventionism in healthcare.
To avoid the indiscriminate use of antibiotics (very often unnecessary,
with the subsequent unjustified increase of bacterial resistances)
Intervention types:

48. LEVELS
OF
PREVENTION
Primordial
Individual and mass
education
Primary
Health promotion
Health education
Environmental modification
Nutritional interventions
Lifestyle changes
Specific protection
Immunization
Chemoprophylaxis
Avoidance of risk factors
Secondary
Early diagnosis and
prompt treatment
Tertiary
Disability limitation
Rehabilitation
Medical
Vocational
Social
Psychological
Quaternary

49. CONCEPTS
OF
DISEASE
CONTROL

50. DISEASE CONTROL

Describes (ongoing) operations aimed at reducing:
🞑 The incidence of disease
🞑 Duration of disease (risk of transmission)
🞑 Effects of infection (both physical and psychosocial)
🞑 Financial burden to the community

Mainly focused on primary and secondary prevention

51. Publichealthapproachtodiseasecontrol

52. Diseasecontrolincludes. ..
Control
Elimination
Eradication
Extinction
public policy intervention that restricts the circulation of an
infectious agent beyond the level that would result from
spontaneous, individual behaviors to protect against infection
Reduction to zero of the incidence of a specified disease in a
defined geographical area as a result of deliberate efforts
Termination of all transmission of infections
by extermination of infectious agents
The specific infectious
agent no longer exists in
nature or in the laboratory

53. Frameworkforeradication
Scientific
considerations
Operational
considerations
Economic
considerations

54. Surveillance

Surveillance: continuous scrutiny of the factors that
determine the occurrence and distribution of disease
and other conditions of ill-health

Objectives of surveillance:
🞑 To provide information about new and changing trends in
health status of a population
🞑 To provide feed back which may beexpected tomodify
policy and system
🞑 Provide timely warning of public health disasters so that
interventions can be mobilized

55. Role of health care provider
video

56. CONCLUSION

Understanding disease pathology is the first step
towards formulating preventive measures

Prevention can be achieved in any stage of disease

Primordial or primary prevention is most effective
and economical

Disease control is also a part of prevention which is
achieved by means of continuous monitoring and
surveillance of disease