H&I III: exam 1: levels of prevention

what is upstream prevention

proactive, critically thinking about populations, as well as families and individuals

what is primary prevention

interventions that promote health, prevent the occurrence of disease injury or disability

ex of primary interventions

brochures to teach about eating healthy--> removing the unhealthy foods from the vending machine

what is secondary prevention

interventions designed to detect disease in early stage before s/s

-intervene early

ex of secondary prevention

-screenings

-recommending mammograms for all women over 50 --> providing free mammograms with a van that comes to an impoverished community once per month

what is tertiary prevention

-aimed at tx or other interventions to lessen the course of disease

-prescribing HTN tx as soon as someone receives a HTN dx --> guaranteeing that HTN meds will be affordable or free of charge for anyone with the dx

what is primary prevention 2.0

-addressing the cause of the problem before the problem occurs

-focus on socially disadvantaged populations

ex of primary prevention

lead exposure in children

-population based environmental policies banned lead in gasoline, paint, drinking water pipes, food and beverage containers

-blood lead levels in children declined from 90% from 1976-2002

-• Fund free in-home blood screening programs for at-

risk children - socially disadvantaged children are

screened, and home environment is assessed

• If lead is found (in child or in the home) loop back and

connect to a program that would provide the

remediation, relocation of the family, etc. in a way that

family could afford (or free)

what does secondary prevention 2.0 do

make the screenings available to those being disproportionately impacted

what is tertiary prevention 2.0

tx, support, and rehab for children with lead poisoning complications

ex of tertiary prevention 2.0

Lead exposure in children

• Lead chelation of blood and soft tissues

can reduce immediate toxicity, but does

not reverse neurocognitive effects

• Other measures to support child to cope

with permanent effects in school and

behaviorally

• Policies that require these interventions

were free for socially disadvantaged groups

the case for upstream primary prevention

• We know that direct medical

interventions (secondary and tertiary)

only comprises a small proportion of

what goes into producing healthier

outcomes

• If we had to choose the most impactful

type of prevention, it would be

upstream primary prevention

• Anything downstream or anything

secondary/tertiary is "too late and at a great price"

components of US healthcare

Health care makes up 17.7% of

US economy - employing 11% of

US workers - but this growth is

unsustainable

• Cost: spending on health care

(secondary/tertiary) is rising

exponentially without us having better outcomes

RN role in upstream prevention

• Critical thinking

• You will be faced with many

scenarios in acute care settings that

have upstream causes and upstream

solutions

• We want you to be able to think

critically to figure out solutions

• This will improve your patient's health outcomes

which of the following would have the greatest impact on health outcomes (SATA)

A. Dental screenings

B. Water fluoridation

C. Patient education about

immunizations

D. Immunization

requirements to enter schools

B- water fluoridation

C- immunization requirements to enter schools

Which of the following would be considered the

most upstream intervention for addressing high

rates of childhood obesity among children living in

poverty?

A. My Plate brochures

B. Screen for diabetes

C. Raise the minimum wage

D. Fund nutritional counseling

raise the minimum wage