promoting health and preventing illness

block two week 3 socpop

disease prevention

• Actions aimed to:

  • Eradicate, eliminate, or minimise disease

  • Minimise subsequent disability

• If eradication is not feasible:

  • Aim to slow disease progression

health promotion

• Process of enabling people to:

  • Increase control over their health

  • Increase control over determinants of health

• Focuses on:

  • Improving quality of life

  • Mental and spiritual wellbeing

• Health viewed as a positive and inclusive concept

levels of prevention (Leavell and Clark)

• Primordial prevention

• Primary prevention

• Secondary prevention

• Tertiary prevention

cardiovascular disease progression and prevention types

• Healthy state

• Development of risk factors:

  • Hypertension

  • Diabetes

• Arterial wall stress → damage

• Cholesterol deposition → atherosclerosis

• Coronary artery stenosis

• Myocardial infarction

• Risk of recurrent myocardial infarction

tertiary prevention

• Treating established disease

• Preventing complications and disability

tertiary prevention in CV disease

• Preventing long-term breathlessness post-MI

• Reducing risk of recurrent MI

• Cardiac rehabilitation

• Angioplasty and stent

• Coronary artery bypass graft (CABG)

secondary prevention

• Detecting disease early before symptoms (preclinical disease)

• Preventing progression to clinical disease

examples of secondary prevention

• Risk scoring (e.g. QRISK3)

• Identifying high-risk individuals

• Aggressive management of risk factors

• Education

primary prevention

• Preventing disease before it occurs

• Addressing known risk factors

primary prevention in CV disease

• Managing hypertension

• Managing diabetes

• Reducing cholesterol

• Lifestyle education

primordial prevention

• Preventing the development of risk factors

• Keeping healthy people healthy

primordial prevention examples

• Addressing socioeconomic deprivation

• Health education

• Promoting healthy lifestyles

levels of prevention in asthma

• primordial:

  • Prevent uptake of smoking in society

  • Smoking cessation support for future parents

• primary:

  • Smoking cessation in parents

• secondary:

  • Identifying allergen sensitisation

  • Monitoring children with family history of atopy

• tertiary:

  • Preventing severe asthma exacerbations

  • Regular asthma reviews

  • Escalation up asthma treatment ladder

high risk approach to prevention

• Targets individuals above a defined risk threshold

• Example: treating people with high blood pressure only

advantages to high risk approach

• Large benefit to treated individuals

• Cost-effective

• High motivation for patients and clinicians

limitations to high risk approach

• Requires screening or case finding

• Does not address underlying causes

• New cases continue to develop

population approach

• Targets entire population

• Shifts risk factor distribution

advantages to the population approach

• Reduces prevalence and incidence

• Larger population-level impact

limitations to the population approach

• Low motivation for individuals and clinicians

• Treats people who may never benefit

• May penalise already healthy individuals

prevention paradox

• Population-level interventions prevent more cases overall

• Even though individual benefit may be small

• Particularly relevant for widespread risk factors

examples of prevention paradox

• Mild hypertension affects many people

• Severe hypertension affects few

• Targeting mild hypertension population-wide prevents more heart disease overall

upstream approaches

• aims to prevent root causes that have broad health consequences such as the wider determinants of health

• e.g: reduce poverty and unemployment, water fluoridation

downstream approaches

• prevention through dealing with lifestyles and adverse health behaviours, and the consequences of poor health

• e.g: smoking cessation and indoor ban, weight management

Beattie’s model of health promotion