CONCEPTS OF
PREVENTION
DR. MAHESWARI JAIKUMAR.
maheswarijaikumar2103@gmail.com

• 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
word “prevention”.

• 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
applied.

• The objective of preventive
medicine is to intercept or
oppose the “cause” & thereby
the disease process.

LEVELS OF PREVENTION
• 1. Primordial prevention.
• 2. Primary prevention.
• 3. Secondary prevention.
• 4. Tertiary prevention.

PRIMORDIAL PREVENTION
• 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
appeared.

• The main intervention in
primordial prevention is through
individual & mass education

PRIMARY PREVENTION
• 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
health problem.
• 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
life”.

• It concerns an individual’s
attitude towards life & health &
the initiative he takes about
positive & responsible measures
for himself, his family & his
community.

• 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
primary prevention.
1. Population Strategy ( Mass
strategy)
2. High risk strategy

POPULATION STRTEGY
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
goal.
• It is worthwhile to recall the fact
that industrialized countries
succeeded in eliminating
communicable diseases by rising
the standard of living (primary
prevention)

• 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.

SECONDARY PREVENTION
• Secondary prevention can be
defined as “action which halts the
progress of a disease at its
incipient stage & prevents
complications”.

• 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
infectious diseases.

• 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
productivity.

• Secondary prevention is an
imperfect tool in the control of
transmission of disease.
• It is more often expensive & less
effective than primary
prevention.

TERTIARY PREVENTION
• When disease process has
advanced beyond its early
stages, it is still possible to
accomplish prevention by what
might be called “tertiary
prevention”.

• It signifies intervention in the late
pathogenesis phase.
• 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
irremediable conditions.

• The main interventions include
disability limitation &
rehabilitation.
• Tertiary prevention extends the
concept of prevention into fields
of rehabilitation.

THE THREE “C” OF
PREVENTION

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 &
treatment.
4. Disability limitation.
5. Rehabilitation.

THE ICEBERG PHENOMENON

HEALTH PROMOTION
• 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

HEALTH EDUCATION
•Is one of the 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 & if
they were encouraged to take
necessary precautions in time.

ENVIRONMENTAL MODIFICATIONS
• A comprehensive approach to
health promotion requires
environmental modifications
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
physician.
• History has shown that many
developed countries have made
remarkable progress in health of its
people through environmental
modification.

NUTRITIONAL INTERVENTION
• These comprise of food
distribution & nutrition
improvement of vulnerable
groups; child feeding
programmes; food fortification;
nutrition education.

LIFE STYLE & BEHAVIOURAL
CHANGES
• 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
them.
• It involves organizational, political,
social & economic interventions
designed to facilitate environmental &
behavioural adaptation that will
improve or protect health.

SPECIFIC PROTECTION
• 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
occupational hazards.
• 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
contacts.

• Secondary prevention is largely
the domain of clinical medicine.
• The health programmes initiated
by the governments are usually
at the level of secondary
prevention

• 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
community development.

EARLY DIAGNOSIS &
TREATMENT
• WHO defines early detection as the
detection of disturbances of
homoeostatic & compensatory
mechanism while bio chemical,
morphological & functional changes
are still reversible.

• Early detection & treatment are
the main interventions of
disease control.

MASS TREATMENT APPROACH
• A mass treatment approach of
used in the control of certain
diseases (yaws, pinta, trachoma,
malaria).

• 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.

DISABILITY LIMITATION
• 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
impairment.
• (In case of leprosy damage to nerves
– primary limitation may lead to
plantar ulcers – secondary
impairment).

• 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
experiences certain
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
individual.

• Accident------Disease or disorder.
• Loss of foot-----Impairment
(extrinsic or intrinsic)
• Cannot walk-----Disability
(objectified)
• Unemployed----- Handicap
(socialized)

DISABILITY PREVENTION
• “Disability prevention” relates to
all levels of prevention.
• Reducing occurrence of
impairment---immunization.

• Disability limitation by
appropriate treatment (secondary
prevention).
• Preventing the transition of
disability into handicap (tertiary
Prevention)

REHABILITATION
• 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
integration.
• Rehabilitation has emerged in
recent years as a medical specialty.

• The following areas of concern in
rehabilitation have been identified :
• 1. Medical rehabilitation --- Restoration
of function.
• 2. Vocational rehabilitation ---
Restoration of the capacity to Earn a
livelihood.

• 3. Social rehabilitation ---
Restoration of family & social
relationships.
• 4. Psychological rehabilitation ---
Restoration of personal
dignity & confidence.

THANK YOU

William Shakespeare
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
called England's
national poet and the
"Bard of Avon".

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