• The goal of medicine is to
promote, to preserve, to restore
health when it is impaired & to
minimize suffering & distress.
• These goals are embodied in the
• Successful prevention depends
upon a knowledge of causation,
dynamics of transmission,
identification of risk factors & risk
groups, availability of prophylactic
or early detection & treatment
measures to appropriate persons,
groups & continuous evaluation of
& development of procedures
• The objective of preventive
medicine is to intercept or
oppose the “cause” & thereby
the disease process.
• This primary prevention is purest
in its sense.
• It implies prevention of the
emergence or development of
risk factors in population groups
in which they have not yet
• The main intervention in
primordial prevention is through
individual & mass education
• Primary prevention can be
defined as “action taken prior to
the onset of disease, which
removes the possibility that a
disease will occur”.
• It signifies intervention in the pre
pathogenesis phase of a disease or
• Primary prevention may be
accomplished by measures designed
to promote general health & well
being, & quality of life of people or
by specific protective measures.
• Primary prevention is far more than
averting the occurrence of a disease
& prolonging life.
• It includes the concept of “positive
health”, a concept that encourages
achievement & maintenance of “an
acceptable level of health that will
enable every individual to lead a
socially & economically productive
• It concerns an individual’s
attitude towards life & health &
the initiative he takes about
positive & responsible measures
for himself, his family & his
• The concept of primary
prevention is now applied for
the prevention of chronic
disease such as heart disease,
hypertension & cancer based on
elimination or modification of
“risk factors” of disease.
• WHO has recommended the
following approaches for the
1. Population Strategy ( Mass
2. High risk strategy
The population strategy is directed at
the whole population irrespective of
individual risk levels.
• E.g., Even a small reduction in the Bp
or serum cholesterol of a population
would produce a large reduction in the
incidence of cardio vascular disease.
HIGH RISK STATERGY
• The high risk strategy aims to
bring preventive care to
individuals at special risk.
• This requires detection of
individuals at high risk by the
optimum use of clinical methods.
• Primary prevention is a desirable
• It is worthwhile to recall the fact
that industrialized countries
succeeded in eliminating
communicable diseases by rising
the standard of living (primary
• In summary, primary prevention
is a holistic approach.
• It relies on measures designed to
promote health or protect
against specific disease “agents ”
& hazards in the environment.
• It utilizes the knowledge of the
pre pathogenesis phase of
disease embracing the agent,
host & the environment.
• The safety & low cost of primary
prevention justifies its wider
application. Primary prevention
has become increasingly
identifies with “health
education” & the concept of
individual & community
responsibility for health.
• The specific interventions are early
diagnosis & prompt treatment.
• Secondary prevention attempts to
arrest the disease process, restore
health by seeking out unrecognized
disease & treating it before irreversible
pathological changes have taken place
& reverse communicability of
• Secondary prevention is largely
the domain of clinical medicine.
• The health programmes initiated
by the government are at the
level of secondary prevention.
• The drawback of secondary
prevention is that the patient
has already been subject to
mental anguish, physical pain &
the community to loss of
• Secondary prevention is an
imperfect tool in the control of
transmission of disease.
• It is more often expensive & less
effective than primary
• When disease process has
advanced beyond its early
stages, it is still possible to
accomplish prevention by what
might be called “tertiary
• It signifies intervention in the late
• Tertiary prevention can be defined as
“all measures available to reduce or
limit impairments & disabilities,
minimize suffering caused by existing
departures from good health & to
promote the patient’s adjustment to
• The main interventions include
disability limitation &
• Tertiary prevention extends the
concept of prevention into fields
MODES OF INTERVENTION
• Intervention is defined as any attempt
to intervene or interrupt the usual
sequence in the development of
disease in man.
• Five modes of intervention have been
described depending upon the natural
history of disease.
Modes of intervention
1. Health Promotion.
2. Specific protection.
3. Early diagnosis &
4. Disability limitation.
• Health promotion is the process of
enabling people to increase control
over & to improve health. It is not
directed against any particular
disease, but is intended to
strengthen the host through a variety
of approaches (interventions) .
•The interventions are :
• 1. Health Education.
• 2. Environmental modifications.
• 3. Nutritional interventions.
• 4. Life style & behavioral changes
• A large number of diseases
could be prevented with little
or no medical intervention if
people were adequately
informed about them & if
they were encouraged to take
necessary precautions in time.
• A comprehensive approach to
health promotion requires
such as provision of safe water,
installation of sanitary latrines,
control of insects & rodents,
improvement of housing etc.
• Environmental interventions are
non clinical & does not require
• History has shown that many
developed countries have made
remarkable progress in health of its
people through environmental
• These comprise of food
distribution & nutrition
improvement of vulnerable
groups; child feeding
programmes; food fortification;
LIFE STYLE & BEHAVIOURAL
• The conventional public health
measures or interventions have
not been successful in making
inroads in to lifestyle reforms.
• Health education is a basic
element of all health activity,
in changing the views,
behaviors & habits of people.
• A well conceived health promotion
programme identifies the target groups
& directs appropriate message to
• It involves organizational, political,
social & economic interventions
designed to facilitate environmental &
behavioural adaptation that will
improve or protect health.
• The following are some of the
currently available interventions
aimed at the specific protection.
• 1. Immunization.
• 2. Use of specific nutrients.
• 3. Chemoprophylaxis.
• 4. Protection against
• 5. Protection against accidents.
• 6. Protection from carcinogens
• 7. Avoidance of allergens.
• 8. Control of specific hazards.
• 9. Control of consumer product
quality & safety of foods,
drugs, & cosmetics.
• It also protects others in the
community from acquiring the
infection & thus provide
secondary prevention for the
infected individuals & primary
prevention for their potential
• Secondary prevention is largely
the domain of clinical medicine.
• The health programmes initiated
by the governments are usually
at the level of secondary
• Health protection is defined as “the
provision of conditions for normal &
physical functioning of the human
being individually & in the group.
• Health protection is considered as
an integral part of the overall
EARLY DIAGNOSIS &
• WHO defines early detection as the
detection of disturbances of
homoeostatic & compensatory
mechanism while bio chemical,
morphological & functional changes
are still reversible.
• There are many variants in mass
treatment. They are ; total mass
treatment, juvenile mass
treatment; selective mass
treatment; depending upon the
nature & prevalence of disease
in the community.
• The objective of this intervention is
to prevent or halt the transition of
the disease process from
impairment to handicap.
CONCEPT OF DISABITLITY
DISEASE IMPAIRMENT DISABILITY HANDICAP
IMPAIRMENT : Any loss or abnormality
of psychological, physiological or
anatomical structure or function.
• E.g., loss of foot, defective vision.
• An impairment may be visible or
invisible, temporary or permanent
& may or may not lead to secondary
• (In case of leprosy damage to nerves
– primary limitation may lead to
plantar ulcers – secondary
• DISBILITY : Because of an
impairment the affected person
may be unable to carry out certain
activities considered normal for his
age, sex. Disability has been defined
as “ any restriction or lack of ability
to perform an activity in the manner
or within the range considered
normal for a human being
• HANDICAP : As a result of
disability, the person
disadvantages in life & is not
able to discharge the obligations
required of him & play the role
expected of him in the society.
• “Handicap” may be defined as a
disadvantage for a given
individual, resulting from an
impairment or a disability, that
limits or prevents the fulfillment
of a role that is normal for that
• Accident------Disease or disorder.
• Loss of foot-----Impairment
(extrinsic or intrinsic)
• Cannot walk-----Disability
• Unemployed----- Handicap
• Disability limitation by
appropriate treatment (secondary
• Preventing the transition of
disability into handicap (tertiary
• Rehabilitation has been defined as “
the combined & coordinated use of
medical, social, educational &
vocational measures for training the
individual to the highest possible
level of functional ability.
• It includes all measures aimed at
reducing the impact of disabling &
handicapping conditions & at
enabling the disabled &
handicapped to achieve social
• Rehabilitation has emerged in
recent years as a medical specialty.
• The following areas of concern in
rehabilitation have been identified :
• 1. Medical rehabilitation --- Restoration
• 2. Vocational rehabilitation ---
Restoration of the capacity to Earn a
• 3. Social rehabilitation ---
Restoration of family & social
• 4. Psychological rehabilitation ---
Restoration of personal
dignity & confidence.
was an English poet,
playwright, and actor,
widely regarded as the
greatest writer in the
English language and
the world's pre-eminent
dramatist. He is often
national poet and the
"Bard of Avon".
• All's Well That Ends Well
As You Like It
Comedy of Errors
Love's Labour's Lost
Measure for Measure
Merchant of Venice
Merry Wives of Windsor
Much Ado about
Taming of the Shrew
Two Gentlemen of
Henry IV, Part I
Henry IV, Part II
Henry VI, Part I
Henry VI, Part II
Henry VI, Part III
Antony and Cleopatra
Romeo and Juliet
Timon of Athens
Troilus and Cressida