Disease prevention: levels and strategiesPHE 6 Flashcards
prevention :
In addressing a risk behaviour, risk factor or disease condition, preventive action aims to :
1- — it, e.g. —
2- Reduce the risk of — it, e.g. — and — disease
3– —- its impact should it occur e.g. exercise in people with —
eradict it as small pox
developing
smoking and lung cancer
limit
diabetes
how can we prevent CVD disease:
WHOs 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases
Geoffrey Rose (1926-1993) and The Prevention Paradox
Rose’s 1985 paper “Sick individuals and sick populations“ is often referred to as The Prevention Paradox.
levels of prevention are:
primodial prevention , primary prevention, 2ndary , teritary
- Primordial prevention aims to — future hazards to health, — the establishment of – factors (environmental, economic, social, behavioural, cultural) exmaple:
- Government — :
i.e. increasing taxes on cigarettes, decreasing advertisement of tobacco, increasing taxes on sugar etc.
-Built — :
i.e. access to safe walking paths, access to stores with healthy food options - Primary prevention aims at — the — of disease (i.e. preventing new cases of disease, e.g. — )
minimize
inhibit
risk factors
policy
enviornment
loweirng
occurernces
immunisation
levels of prevention:
1-Health promotion ( — ) Environmental, nutrition, lifestyle and behavioral
2- Specific protection ( — ) Immunization, nutrient or supplement, occupational hazard protection
- primary prevention strategies:
Strategies may involve:
- Health sector ( — )
- Multisector (—)
Strategies can address:
- — population or
- Those at – risk (e.g. in overweight to prevent diabetes)
- — (complementary to one another)
primodial
primary
immunisation
road accidents
whole
high risk
both
- Secondary prevention aims at — and — in its — stages before it results in — (e.g. screening, medication for osteoporosis), or to prevent — (e.g. treatment to reduce risk of recurrence of a heart attack)
- Tertiary prevention aims to – the — impact of — disease and reduce — (e.g. — from diabetes, — after spinal injury or amputation)
early diagnosis
treatment
early
morbidity
prevent recurrence
reduce
-ve impact
existinf
reduce complications
blindness
rehabilitation
1- Preventing the development of risk factors for atherosclerosis that include: dyslipidemia, smoking, high blood pressure, high blood glucose and BMI - Addressing alcohol intake, unhealthy diet, physical inactivity and air pollution
Legislative policies: smoking bans, taxation on sugary drinks, sodium restriction strategies, nutritional labelling, regulation of marketing is under —-
2- Early identification of individuals at high risk of CVD and managing modifiable risk factors - Validated risk assessment/stratification tools to evaluate CVD risk factors e.g. Framingham cardiovascular risk calculator Modifying risk factors through diet, lifestyle changes and medication to control diabetes, hypertension and hyperlipidemia are under —
3- Reducing the probability of CVD recurrence and mortality - Early diagnosis to direct treatment improve quality of life and reduce treatment costs
Interventions that include lifestyle changes and medical interventions to prevent progress are under —
4- Increasing life expectancy and managing pain - Increasing life expectancy and managing pain are under —
primodial prevention
primary prevention
seocndary prevention
teirtary
In practice, there is overlap between primary and secondary prevention:
1- Primary prevention: For the — population and for individuals identified as being at — risk based on measurement of risk factors.
2- Secondary prevention: Aims at — and — in its early stages before it results in morbidity or to prevent —
Division between the two is not always clear:
-We can identify atherosclerosis before symptoms e.g. ultrasound of carotid arteries. Is intervention to reduce risk primary prevention (person does not have symptoms) or secondary (person has evidence of pathology)?
-Treatment is the same for high risk (no symptoms) and symptomatic i.e. 1° and 2° prevention
genreal
high riskk
early diagnosis and treatment
reoccurence
1- Clean water, disposal of sewage
Government policy- Seat belt enforcement, drink driving legislation
Smokeless fuel legislation
Built environment- safe walking paths
Education (in general), Health literacy & health education are under —
2- Immunisation , vitamin supplements
Smoking cessation. , Change in infant sleeping position are under —
3- Screening , Cancer (mammography, bowel screening) Treatment (medication) are under—-
4- Rehabilitation after injury, amputation
Laser treatment of retinopathy in diabetes are under—
primordial prevention
primary
2ndary
teritary
prevention programmes are interventions to be sustained to maintain — as reducing childhood obesity. these can be — , — , — levels
maintain benefits
indiviuals enviromnetal and societal levels
1- passive intervention are those that provide — protection without — from an indiviual
2- active intervention are those that require —- for the intervention to be effective
- Passive measures (e.g. road engineering) :
Protect — , require little or no — or — on part of individuals.
However, passive measures may not be possible because:
- Insufficient — ,
- — unacceptable, and/or
- No passive — available.
In practice programmes are often a mix of passive and active interventions.
automatic
action
indiviual action
everyone
cooperation or action
resources
socially
startegy
( check slide 32 )
1- the prevention paradox- Geoffary Rose:
2- Population and High Risk StrategiesRationale for Population Strategy - In some populations, the majority of people are at increased risk of coronary heart disease e.g. Finland versus Japan
circa 1960
Geoffrey Rose – sick individuals and sick populations
Sick Individuals
“Illness is a personal event: it happens to individuals and the objective of preventive medicine is the avoidance of a series of individual misfortunes, and so it is natural to believe that preventive action should be targeted on the individuals at risk” (Rose, 1992:29).
Sick Populations
However, “the population strategy of prevention starts with the recognition that the occurrence of common diseases and exposures reflects the behaviour and circumstances of society as a whole. This recognition rests on sociological, moral, and medial grounds” (Rose, 1992:95).
rationale for population startegy:
- The higher the level of cholesterol or of blood pressure of the total estimated risk, the — the risk of an event .
- If only a small proportion of the population are in highest risk group- treating them is important— but will make — impact on population burden of disease.
higher
clinically
little
1- rationale population startegy:
- Reducing risk, even to small extent, in the majority of the population will make — impact on population burden of disease.
- Each individual benefits to — extent but adds to — benefit for the population.
-Analogy of larger profits in high turnover, fast food restaurant vs. expensive restaurant – latter has larger profit / customer but fewer clients, so lower total profit.
2- prevention of CVD :
- A combination of — wide and — strategies are required to shift the CVD risk distribution of populations to more optimal levels.
-The individual approach (detecting those at greatest risk): lifestyle guidelines (e.g., smoking cessation)
-The population-wide approach: (the whole population, western lifestyle, e.g. reducing the amount of salt added to processed food, eliminating trans fat from our diet)
greatest
small
large
population and high risk strategies
check slide 47
1- population startegy ( its basically to reduce the risk of a whole population by snall amount as envirmnetal changes , lifestyle )
advanatges :
- is —
- — portential for population
- behaviorlaly —
disadvantage:
- — benefits to indiviuals
- — motivation of subject and health porfessioanals
- benefit to risk ratio might be —
2- high risk ( reduce risk in ppl w high risk of developing diebtes )
advanatges:
- Tailored to the — , with — professional & patient motivation
- Benefit-to-risk ratio is — i.e. potential for benefit outweighs risk of adverse events
disdvantages:
-High screening — to identify those at high risk
-Effects are — and —
- Behaviorally — i.e. the person is asked to behave differently to most people in that society
radical
large
appropriate
small
poor
low
indiviual
high
favorable
costs
temporary and limited
inapproproate
1- relative importance:
- The four levels of prevention, are ALL important and complementary
But: – and — prevention has the most to contribute to the health and wellbeing of the whole population.
- Population approaches are estimated to cost, on average,– times less than individual approaches
prevention and health services:
2- Health services can have big impact on some conditions e.g. through — and —
- A lot of focus on — and — prevention: — and effective — of disease to minimise impact
- Health service can be a leader for change ( — prevention)
e.g. smoke free campus, low salt bread available, vending machine culture, breastfeeding promotion
- Health service can be an advocate for primordial and primary prevention
e.g. by promoting initiatives with Local Authorities (walking), Schools (diet), Government (access to alcohol)
-Challenging for health services to support change in health behaviours to reduce risk
-Vigorous and sustained lifestyle interventions shown to be effective e.g. Finnish Diabetes study to reduce blood glucose levels through lifestyle advice or Croi MyAction programme in Ireland
primodial and primary
5
immunisation and screening
2ndary and teitary
detection and effective treatment
primary
prevention and health services:
- Professionals have a role to — for health e.g. Action on Smoking and Health (ASH Ireland)
- To take every opporitunity to — illness/injury e.g. brief intervention training (smoking)
- Remember – of prevention also important - often intervening in people who are well. ‘Primum non nocere’ First, do no harm (Non-maleficence)
advocate
prevent
ethics
