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 | The examples and perspective in this article may not represent a worldwide view of the subject. (March 2023) |
| Occupation | |
|---|---|
| Names |
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Occupation type | Specialty |
Activity sectors | Medicine |
| Description | |
Education required |
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Fields of employment | Hospitals, clinics |
Preventive healthcare, or prophylaxis, is the application of healthcare measures to prevent diseases.[1] Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices, and are dynamic processes that begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal,[2][3] primary, secondary, and tertiary prevention.[1]
Each year, millions of people die of preventable causes. A 2004 study showed that about half of all deaths in the United States in 2000 were due to preventable behaviors and exposures.[4] Leading causes included cardiovascular disease, chronic respiratory disease, unintentional injuries, diabetes, and certain infectious diseases.[4] This same study estimates that 400,000 people die each year in the United States due to poor diet and a sedentary lifestyle.[4] According to estimates made by the World Health Organization (WHO), about 55 million people died worldwide in 2011, and two-thirds of these died from non-communicable diseases, including cancer, diabetes, and chronic cardiovascular and lung diseases.[5] This is an increase from the year 2000, during which 60% of deaths were attributed to these diseases.[5]
Preventive healthcare is especially important given the worldwide rise in the prevalence of chronic diseases and deaths from these diseases. There are many methods for prevention of disease. One of them is prevention of teenage smoking through information giving.[6][7][8][9] It is recommended that adults and children aim to visit their doctor for regular check-ups, even if they feel healthy, to perform disease screening, identify risk factors for disease, discuss tips for a healthy and balanced lifestyle, stay up to date with immunizations and boosters, and maintain a good relationship with a healthcare provider.[10] In pediatrics, some common examples of primary prevention are encouraging parents to turn down the temperature of their home water heater in order to avoid scalding burns, encouraging children to wear bicycle helmets, and suggesting that people use the air quality index (AQI) to check the level of pollution in the outside air before engaging in sporting activities. Some common disease screenings include checking for hypertension (high blood pressure), hyperglycemia (high blood sugar, a risk factor for diabetes mellitus), hypercholesterolemia (high blood cholesterol), screening for colon cancer, depression, HIV and other common types of sexually transmitted disease such as chlamydia, syphilis, and gonorrhea, mammography (to screen for breast cancer), colorectal cancer screening, a Pap test (to check for cervical cancer), and screening for osteoporosis. Genetic testing can also be performed to screen for mutations that cause genetic disorders or predisposition to certain diseases such as breast or ovarian cancer.[10] However, these measures are not affordable for every individual and the cost effectiveness of preventive healthcare is still a topic of debate.[11][12]
Overview
Preventive healthcare strategies are described as taking place at the primal,[2] primary,[13] secondary, and tertiary prevention levels. Although advocated as preventive medicine in the early twentieth century by Sara Josephine Baker,[14] in the 1940s, Hugh R. Leavell and E. Gurney Clark coined the term primary prevention. They worked at the Harvard and Columbia University Schools of Public Health, respectively, and later expanded the levels to include secondary and tertiary prevention. Goldston (1987) notes that these levels might be better described as "prevention, treatment, and rehabilitation", although the terms primary, secondary, and tertiary prevention are still in use today. The concept of primal prevention has been created much more recently, in relation to the new developments in molecular biology over the last fifty years,[15] more particularly in epigenetics, which point to the paramount importance of environmental conditions, both physical and affective, on the organism during its fetal and newborn life, or so-called primal period of life.[3]
| Level | Definition |
|---|---|
| Primal and primordial prevention |
Primal prevention has been propounded as a separate category of health promotion based on the evidence that epigenetic processes start at conception (see below: Primal and primordial preventions). Primordial prevention refers to measures designed to avoid the development of risk factors in the first place, early in life.[16][17] |
| Primary prevention | Methods to avoid occurrence of disease either through eliminating disease agents or increasing resistance to disease.[18] Examples include immunization against disease, maintaining a healthy diet and exercise regimen, and avoiding smoking.[19] |
| Secondary prevention | Methods to detect and address an existing disease prior to the appearance of symptoms.[18] Examples include treatment of hypertension (a risk factor for many cardiovascular diseases), and cancer screenings.[19] |
| Tertiary prevention | Methods to reduce the harm of symptomatic disease, such as disability or death, through rehabilitation and treatment.[18] Examples include surgical procedures that halt the spread or progression of disease.[18] |
| Quaternary prevention | Methods to mitigate or avoid results of unnecessary or excessive interventions in the health system, including potential violations of rights.[20] |
Primal and primordial preventions
Primal prevention is health promotion par excellence.[21] New knowledge in molecular biology, in particular epigenetics, points to how much affective as well as physical environment during fetal and newborn life may determine adult health.[22][23][24][25] This way of promoting health consists mainly in providing future parents with pertinent, unbiased information on primal health and supporting them during their child's primal period of life (i.e., "from conception to first anniversary" according to definition by the Primal Health Research Centre, London). This includes adequate parental leave, ideally for both parents, with kin caregiving and financial help where needed.[26]
Primordial prevention refers to all measures designed to prevent the development of risk factors in the first place, early in life,[16][17] and even preconception, as Ruth A. Etzel has described it "all population-level actions and measures that inhibit the emergence and establishment of adverse environmental, economic, and social conditions". This could be reducing air pollution[27] or prohibiting endocrine-disrupting chemicals in food-handling equipment and food contact materials.[28]
Primary prevention
Primary prevention consists of traditional health promotion and "specific protection".[18] Health promotion activities include prevention strategies such as health education and lifestyle medicine, and are current, non-clinical life choices such as eating nutritious meals and exercising often, that prevent lifestyle-related medical conditions, improve the quality of life, and create a sense of overall well-being.[29] Preventing disease and creating overall well-being prolongs life expectancy.[1][18] Health-promotional activities do not target a specific disease or condition but rather promote health and well-being on a very general level.[1] On the other hand, specific protection targets a type or group of diseases and complements the goals of health promotion.[18]
Food
Food is the most basic tool in preventive health care. Poor nutrition is linked to various chronic illnesses. Because of this, having a healthy diet and proper nutrition can be used to prevent illnesses.[30]
Access
The 2011 National Health Interview Survey performed by the Centers for Disease Control was the first national survey to include questions about ability to pay for food. Difficulty with paying for food, medicine, or both is a problem facing 1 out of 3 Americans. If better food options were available through food banks, soup kitchens, and other resources for low-income people, obesity and the chronic conditions that come along with it would be better controlled.[31] A food desert is an area with restricted access to healthy foods due to a lack of supermarkets within a reasonable distance. These are often low-income neighborhoods with the majority of residents lacking transportation.[32] There have been several grassroots movements since 1995 to encourage urban gardening, using vacant lots to grow food cultivated by local residents.[33] Mobile fresh markets are another resource for residents in a "food desert", which are specially outfitted buses bringing affordable fresh fruits and vegetables to low-income neighborhoods.[34]
Food education and guidance
It has been proposed that healthy longevity diets are included in standard healthcare as switching from a "typical Western diet" could often extend life by a decade.[35]
Protective measures
Specific protective measures such as water purification, sewage treatment, and the development of personal hygienic routines, such as regular hand-washing, safe sex to prevent sexually transmitted infections, became mainstream upon the discovery of infectious disease agents and have decreased the rates of communicable diseases which are spread in unsanitary conditions.[1]
Scientific advancements in genetics have contributed to the knowledge of hereditary diseases and have facilitated progress in specific protective measures in individuals who are carriers of a disease gene or have an increased predisposition to a specific disease. Genetic testing has allowed physicians to make quicker and more accurate diagnoses and has allowed for tailored treatments or personalized medicine.[1]
Food safety has a significant impact on human health and food quality monitoring has increased.[36] Water, including drinking water, is also monitored in many cases for securing health. There also is some monitoring of air pollution. In many cases, environmental standards such as via maximum pollution levels, regulation of chemicals, occupational hygiene requirements or consumer protection regulations establish some protection in combination with the monitoring.[citation needed]
Preventive measures like vaccines and medical screenings are also important.[37] Using PPE properly and getting the recommended vaccines and screenings can help decrease the spread of respiratory diseases, protecting the healthcare workers as well as their patients.[38][39]
Secondary prevention
Secondary prevention deals with latent diseases and attempts to prevent an asymptomatic disease from progressing to symptomatic disease.[18] Certain diseases can be classified as primary or secondary. This depends on definitions of what constitutes a disease, though, in general, primary prevention addresses the root cause of a disease or injury[18] whereas secondary prevention aims to detect and treat a disease early on.[40] Secondary prevention consists of "early diagnosis and prompt treatment" to contain the disease and prevent its spread to other individuals, and "disability limitation" to prevent potential future complications and disabilities from the disease.[1] Early diagnosis and prompt treatment for a syphilis patient would include a course of antibiotics to destroy the pathogen and screening and treatment of any infants born to syphilitic mothers. Disability limitation for syphilitic patients includes continued check-ups on the heart, cerebrospinal fluid, and central nervous system of patients to curb any damaging effects such as blindness or paralysis.[1]
Tertiary prevention
Finally, tertiary prevention attempts to reduce the damage caused by symptomatic disease by focusing on mental, physical, and social rehabilitation. Unlike secondary prevention, which aims to prevent disability, the objective of tertiary prevention is to maximize the remaining capabilities and functions of an already disabled patient.[1] Goals of tertiary prevention include: preventing pain and damage, halting progression and complications from disease, and restoring the health and functions of the individuals affected by disease.[40] For syphilitic patients, rehabilitation includes measures to prevent complete disability from the disease, such as implementing work-place adjustments for the blind and paralyzed or providing counseling to restore normal daily functions to the greatest extent possible.[1]
The general use of machinery that has adequate ventilation and airflow is suggested for these patients in order to halt progression and complications of disease. A study conducted in nursing homes to prevent diseases concluded that the use of evaporative humidifiers to maintain the indoor humidity within the range 40–60% can reduce respiratory risk. Certain diseases thrive in different humidities, so the use of the humidifiers can help kill the particles of diseases.[39][38]
Leading causes of preventable death
United States
The leading preventable cause of death in the United States is tobacco; however, poor diet and lack of exercise may soon surpass tobacco as a leading cause of death. These behaviors are modifiable and public health and prevention efforts could make a difference to reduce these deaths.[4]
| Cause | Deaths caused | % of all deaths |
|---|---|---|
| Tobacco smoking | 435,000 | 18.1 |
| Poor diet and physical inactivity | 400,000 | 16.6 |
| Alcohol consumption | 85,000 | 3.5 |
| Infectious diseases | 75,000 | 3.1 |
| Toxicants | 55,000 | 2.3 |
| Traffic collisions | 43,000 | 1.8 |
| Firearm incidents | 29,000 | 1.2 |
| Sexually transmitted infections | 20,000 | 0.8 |
| Drug abuse | 17,000 | 0.7 |
Worldwide
The leading causes of preventable death worldwide share similar trends to the United States. There are a few differences between the two, such as malnutrition, pollution, and unsafe sanitation, that reflect health disparities between the developing and developed world.[41]
| Cause | Deaths caused (millions per year) |
|---|---|
| Hypertension | 7.8 |
| Smoking | 5.0 |
| High cholesterol | 3.9 |
| Malnutrition | 3.8 |
| Sexually transmitted infections | 3.0 |
| Poor diet | 2.8 |
| Overweight and obesity | 2.5 |
| Physical inactivity | 2.0 |
| Alcohol | 1.9 |
| Indoor air pollution from solid fuels | 1.8 |
| Unsafe water and poor sanitation | 1.6 |
However, several of the leading causes of death – or underlying contributors to earlier death – may not be included as "preventable" causes of death. A study concluded that pollution was "responsible for approximately 9 million deaths per year" in 2019.[42] And another study concluded that the global mean loss of life expectancy (a measure similar to years of potential life lost) from air pollution in 2015 was 2.9 years, substantially more than, for example, 0.3 years from all forms of direct violence, albeit a significant fraction of the LLE is considered to be unavoidable (such as pollution from some natural wildfires).[43]
A landmark study conducted by the World Health Organization and the International Labour Organization found that exposure to long working hours is the occupational risk factor with the largest attributable burden of disease, i.e. an estimated 745,000 fatalities from ischemic heart disease and stroke events in 2016.[44] With this study, prevention of exposure to long working hours has emerged as a priority for prevention healthcare in workplace settings.[citation needed]
Child mortality
In 2010, 7.6 million children died before reaching the age of 5. While this is a decrease from 9.6 million in 2000,[45] it was still far from the fourth Millennium Development Goal to decrease child mortality by two-thirds by 2015.[46] Of these deaths, about 64% were due to infection including diarrhea, pneumonia, and malaria.[45] About 40% of these deaths occurred in neonates (children ages 1–28 days) due to pre-term birth complications.[46] The highest number of child deaths occurred in Africa and Southeast Asia.[45] As of 2015 in Africa, almost no progress has been made in reducing neonatal death since 1990.[46] In 2010, India, Nigeria, Democratic Republic of the Congo, Pakistan, and China contributed to almost 50% of global child deaths. Targeting efforts in these countries is essential to reducing the global child death rate.[45]
Child mortality is caused by factors including poverty, environmental hazards, and lack of maternal education.[47] In 2003, the World Health Organization created a list of interventions in the following table that were judged economically and operationally "feasible," based on the healthcare resources and infrastructure in 42 nations that contribute to 90% of all infant and child deaths. The table indicates how many infant and child deaths could have been prevented in 2000, assuming universal healthcare coverage.[47]