Concepts of Prevention

and Control
(I) Prevention
 The goals of psychology are to promote mental
health, to preserve mental health, to restore mental
health when it is impaired, and to minimize suffering
and distress.

 These goals are embodied in the word "prevention"

Prevention; Definition and
Concept
 Actions aimed at eradicating,
eliminating or minimizing the impact
of disease and disability, or if none of
these are feasible, retarding the
progress of the disease and disability.
 The concept of prevention is best
defined in the context of levels,
traditionally called primary,
secondary and tertiary prevention. A
fourth level, called primordial
prevention, was later added.
Determinants of Prevention

 Successful prevention depends upon:

 a knowledge of causation,
 dynamics of transmission,
 identification of risk factors and risk groups,
 availability of prophylactic or early detection
and treatment measures,
 an organization for applying these measures
to appropriate persons or groups, and
 continuous evaluation of and development
of procedures applied
Preventable Causes of Disease
BEINGS
Biological factors and Behavioral Factors
Environmental factors
Immunologic factors
Nutritional factors
Genetic factors
Services, Social factors, and Spiritual
factors
[JF Jekel, Epidemiology, Biostatistics, and Preventive Medicine, 1996]
Leavell’s Levels of Prevention

Stage of disease Level of prevention Type of response

Pre-disease Primary Prevention Health promotion and

Specific protection

Latent Disease Secondary prevention Pre-symptomatic

Diagnosis and
treatment

Symptomatic Disease Tertiary prevention •Disability limitation for

early symptomatic disease
•Rehabilitation for late
Symptomatic disease
Levels of prevention

Primordial prevention

Primary prevention

Secondary prevention

Tertiary prevention
Primordial prevention

 Primordial prevention consists of actions and measures

that inhibit the emergence of risk factors in the form of
environmental, economic, social, and behavioral
conditions and cultural patterns of living etc.
 Primordial prevention (cont.)
It is the prevention of the emergence or
development of risk factors in countries
or population groups in which they
have not yet appeared

For example, many adult health

problems (e.g., obesity, hypertension)
have their early origins in childhood,
because this is the time when lifestyles
are formed (for example, smoking,
eating patterns, physical exercise).
Primordial prevention (cont.)

 In primordial prevention, efforts are directed towards

discouraging children from adopting harmful lifestyles

 The main intervention in primordial prevention is

through individual and mass education
Primary prevention

 Primary prevention can be defined as

the action taken prior to the onset of
disease, which removes the possibility
that the disease will ever occur.
 It signifies intervention in the pre-
pathogenesis phase of a disease or
health problem.
 Primary prevention may be
accomplished by measures of
“Health promotion” and “specific
protection”
Primary prevention (cont.)

 It includes the concept of "positive

health", a concept that encourages
achievement and maintenance of "an
acceptable level of health that will
enable every individual to lead a socially
and economically productive life".
 Primary prevention may be
accomplished by measures designed to
promote general health and well-being,
and quality of life of people or by
specific protective measures.
 Primary prevention

Achieved by

Health promotion Specific protection

Immunization and seroprophylaxis

Health education
chemoprophylaxis
Use of specific nutrients or supplementations
Environmental modifications
Protection against occupational hazards
Nutritional interventions Safety of drugs and foods
Life style and behavioral changes Control of environmental hazards,
e.g. air pollution
Health promotion

 Health promotion is “ the process of enabling people

to increase control over the determinants of health
and thereby improve their health”.
Approaches for Primary
Prevention
 The WHO has recommended the following
approaches for the primary prevention of chronic
diseases where the risk factors are established:

 a. Population (mass) strategy

 b. High -risk strategy
Population (mass) strategy

 “Population strategy" is directed at the

whole population irrespective of individual
risk levels.

 For example, studies have shown that even

a small reduction in the average blood
pressure or serum cholesterol of a population
would produce a large reduction in the
incidence of cardiovascular disease

 The population approach is directed

towards socio-economic, behavioral and
lifestyle changes
High -risk strategy

 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.
Secondary prevention

 It is defined as “ action which halts the progress of a

disease at its incipient stage and prevents
complications.”

 The specific interventions are: early diagnosis (e.g.

screening tests, and case finding programs….) and
adequate treatment.

 Secondary prevention attempts to arrest the disease

process, restore health by seeking out unrecognized
disease and treating it before irreversible pathological
changes take place, and reverse communicability of
infectious diseases.

 It thus protects others from in the community from

acquiring the infection and thus provide at once
secondary prevention for the infected ones and primary
prevention for their potential contacts.
Secondary prevention
(cont.)
 Secondary prevention attempts to arrest
the disease process, restore health by
seeking out unrecognized disease and
treating it before irreversible
pathological changes take place, and
reverse communicability of infectious
diseases.

 It thus protects others from in the

community from acquiring the infection
and thus provide at once secondary
prevention for the infected ones and
primary prevention for their potential
contacts.
Early diagnosis and
treatment
 WHO Expert Committee in 1973 defined
early detection of health disorders as “
the detection of disturbances of
homoeostatic and compensatory
mechanism while biochemical,
morphological and functional changes
are still reversible.”

 The earlier the disease is diagnosed, and

treated the better it is for prognosis of
the case and in the prevention of the
occurrence of other secondary cases.
Tertiary prevention

 It is used when the disease process has

advanced beyond its early stages.
 It is defined as “all the measures
available to reduce or limit impairments
and disabilities, and to promote the
patients’ adjustment to irremediable
conditions.”
 Intervention that should be
accomplished in the stage of tertiary
prevention are disability limitation, and
rehabilitation.
Disability limitation

disease

impairment

disability

handicap
Impairment

 Impairment is “any loss or abnormality of

psychological, physiological or anatomical structure or
function.”
Disability

 Disability is “any restriction or lack of ability to perform

an activity in the manner or within the range
considered normal for the human being.”
Handicap

 Handicap is termed as “a disadvantage for a given

individual, resulting from an impairment or disability,
that limits or prevents the fulfillment of a role in the
community that is normal (depending on age, sex,
and social and cultural factors) for that individual.”
Rehabilitation

 Rehabilitation is “ the combined and coordinated use

of medical, social, educational, and vocational
measures for training and retraining the individual to
the highest possible level of functional ability.”
 Rehabilitation

Medical Vocational Social Psychological

rehabilitation rehabilitation rehabilitation rehabilitation
Strategy for Prevention
Identify
Populations
Modify Existing at High
Disease Risk
Intervention (based on demography /
family history,
Programs host factors..)

Assess
Evaluate Exposure
Intervention
Programs

Conduct
Research on
Apply Mechanisms
(including the study of
Population-Based genetic susceptibility)
Intervention
Programs

Epidemiology Division
(II) Control
Control

 Concept of control:
The term disease control describes
ongoing operations aimed at reducing:
 The incidence of disease
 The duration of disease and consequently the
risk of transmission
 The effects of infection, including both the
physical and psychosocial complications
 The financial burden to the community.
 Control activities focus on primary prevention or
secondary prevention, but most programs combine
both.

control

elimination

eradication
Disease Elimination

 Between control and eradication, an

intermediate goal has been
described, called "regional
elimination"
 The term "elimination" is used to
describe interruption of transmission
of disease, as for example,
elimination of measles, polio and
diphtheria from large geographic
regions or areas
 Regional elimination is now seen as
an important precursor of eradication
 Disease Eradication
 Eradication literally means to "tear out by roots".

 It is the process of “Termination of all transmission

of infection by extermination of the infectious
agent through surveillance and containment”.

 Eradication is an absolute process, an "all or none"

phenomenon, restricted to termination of an
infection from the whole world. It implies that
disease will no longer occur in a population.

 To-date, only one disease has been eradicated,

that is smallpox.
Monitoring

 Monitoring is "the performance and

analysis of routine measurements
aimed at detecting changes in the
environment or health status of
population" (Thus we have monitoring
of air pollution, water quality, growth
and nutritional status, etc).

 It also refers to on -going

measurement of performance of a
health service or a health
professional, or of the extent to which
patients comply with or adhere to
advice from health professionals.
Surveillance

 surveillance means to watch over

with great attention, authority and
often with suspicion

 According to another, surveillance is

defined as "the continuous scrutiny
(inspection) of the factors that
determine the occurrence and
distribution of disease and other
conditions of ill-health"
 Objectives of Surveillance
 The main objectives of surveillance are:

 (a) to provide information about new and changing

trends in the health status of a population, e.g.,
morbidity, mortality, nutritional status or other
indicators and environmental hazards, health
practices and other factors that may affect health

 (b) to provide feed-back which may be expected

to modify the policy and the system itself and lead
to redefinition of objectives, and

 (c) provide timely warning of public health disasters

so that interventions can be mobilized.
 Control of infectious
diseases (the 4 “C”s
Control

Cases Contacts Carriers Community

Diagnosis
notification standard
isolation strict observation detection Epidemiological
protective Investigation &
disinfection containment
treatment
follow up
release
 Evaluation of control
 Evaluation is the process by which results are compared
with the intended objectives, or more simply the
assessment of how well a program is performing.

 Evaluation should always be considered during the
planning and implementation stages of a program or
activity.

 Evaluation may be crucial in identifying the health benefits

derived (impact on morbidity, mortality, sequelae, patient
satisfaction).

 Evaluation can be useful inidentifying performance

difficulties.

 Evaluation studies may also be carried out to generate

information for other purposes, e.g., to attract attention to
a problem, extension of control activities, training and
patient management, etc.
 To summarize
 The goals of medicine are to promote health, to
preserve health, to restore health when it is impaired,
and to minimize suffering and distress.

 These goals are embodied in the word "prevention"

 Successful prevention depends upon a knowledge of

causation, dynamics of transmission, identification of
risk factors and risk groups, availability of prophylactic
or early detection and treatment measures, an
organization for applying these measures to
appropriate persons or groups, and continuous
evaluation of and development of procedures applied

 The objective of preventive medicine is to intercept or

oppose the "cause" and thereby the disease process.
This epidemiological concept permits the inclusion of
treatment as one of the modes of intervention
 Quiz
 Match the following statements. Each option may
be selected once, more than once, or not at all:
 (a) performing carotid endarterectomy in a
patient with transient ischemic attack
 (b) recommending regular physical activity to a
patient with no known medical problem
 (C) vaccinating a health care worker against
hepatitis B
 (d) giving isoniazid for 1 yr to a 28-year-old
medical student with a positive PPD tuberculin skin
test.
 1. primary prevention 2. secondary prevention
 3. tertiary prevention 4. health promotion
Thank You