Prevention strategies (Epidemiology)

Question 1

Define High Risk Prevention strategy

Answer 1

Identifies people at high risk of a disease and reduce their risk i.e. clinical approach

e.g. Identify high risk patients through QRISK scores, use lifestyle and pharmacological measures to reduce risk

Question 2

Define Population Approach to Prevention

Answer 2

Aims to reduce the risk of the whole population i.e. public health approach

e.g taxation of sugary drinks, banning cigarette adverts

Question 3

What determines effectiveness of high risk vs population strategies

Answer 3

Distribution of disease risk in population

Average risk factor levels favour population strategy
High risk factor levels favour a high risk strategy

Question 4

Strengths and weaknesses of High Risk prevention

Answer 4

Strengths
- Can offer a level of intervention appropriate to the individual
- Due to pt high risk the intervention is more likely to be effective and cost effective
- Approach fits within medical model
- Motivation of pt and doctor high
-Avoids interference with low risk groups

Weaknesses
- Process involves screening which provides an imperfect prediction of those at risk and has its own costs and risks
- Some high risk subjects will have already developed disease
- Not a radical approach and unlikely to have an impact on overall incidence in the whole population
- Singles out, medicalises and labels individuals as abnormal

Question 5

Strengths and weaknesses of population prevention strategies

Answer 5

Strengths
-No need for some individuals to behave differently from others
- Large benefits for whole populations, especially where risk is widespread
- Radical and aims to reduce disease incidence
- Does not require screening or identification of high risk groups
- Doesn’t depend on medical care which tends to be expensive

Weaknesses
- Poorly motivated and depends on sense of public purpose/political will
- Benefit for individuals is small
- Prevention paradox - the actual number of cases coming out of high risk population is small, majority come from a population at low/mod risk
- If strategy involves exposure to new factor with potential adverse effects, the gap between benefit and harm may narrow