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Levels of Prevention

The document describes 5 levels of disease prevention: 1) Primordial prevention prevents risk factors through social and environmental control before disease onset. 2) Primary prevention prevents disease initiation through health promotion and specific protections. 3) Secondary prevention prevents disease progression through early diagnosis and prompt treatment. 4) Tertiary prevention prevents serious disease outcomes and dependence through disability limitation and rehabilitation. 5) Quaternary prevention focuses on problems from excess medical care like over-screening and over-diagnosis.

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Sofia Julia
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240 views5 pages

Levels of Prevention

The document describes 5 levels of disease prevention: 1) Primordial prevention prevents risk factors through social and environmental control before disease onset. 2) Primary prevention prevents disease initiation through health promotion and specific protections. 3) Secondary prevention prevents disease progression through early diagnosis and prompt treatment. 4) Tertiary prevention prevents serious disease outcomes and dependence through disability limitation and rehabilitation. 5) Quaternary prevention focuses on problems from excess medical care like over-screening and over-diagnosis.

Uploaded by

Sofia Julia
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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LEVELS OF PREVENTION

LEVELS OF PREVENTION DISEASE STAGE


Primordial Prevention: prevents risk factors
through social and environmental control
Primary Prevention: prevents initiation of
Pre-Pathogenesis
disease
 Health Promotion
 Specific Protection
Secondary Prevention: prevents progression
of disease
 Early Diagnosis and Prompt Treatment Early Pathogenesis
of Diseases
Tertiary Prevention: prevents serious
outcome and complete dependence
Late Pathogenesis
 Disability Limitation
 Rehabilitation
Quaternary Prevention: focuses on the
problems that result from an excess of medical
care, in particular over-screening and over-
diagnosis

STAGES OF THE NATURAL HISTORY OF DISEASE:


I. PRE-PATHOGENESIS: There is preliminary interaction of the potential agent, the
host and environment in disease production, which takes place in the environment.

II. PATHOGENESIS: The process takes place in man, starting with the first interaction
with disease provoking stimuli to change in form and function which results in defect,
disability or death.

LEVELS OF PREVENTION:
Prevention, therefore at any given level of application in the progressive natural
history of disease, depends on the causes related to the agent, host and environmental
factors, and the ease with which the causes may be intercepted or counteracted.
Prevention requires the construction and interposition of various kinds of barriers in the
interaction of these elements. The degree of success in prevention depends on the
completeness of knowledge regarding the natural history of disease, the opportunity to
apply the knowledge and the actual application of it.

I. PRIMORDIAL PREVENTION:
Primordial prevention is defined as prevention of risk factors themselves, beginning
with change in social and environmental conditions in which these factors are observed
to develop. Primordial prevention consists of actions to minimize future hazards to health
and hence inhibits the establishment of factors, which are known to increase the risk of
disease. It addresses broad health determinants rather than preventing personal
exposure to risk factors, which is the goal of primary prevention. Changes in attitudes,
behavior and social values are important for primordial prevention. They include
encouragement of positive health behavior, prevention of adopting risk behavior,
elimination of established risk behavior and promotion of the concept of health as a social
value.

In both the developing and the industrialized parts of the world, primordial
prevention proves to be highly cost-effective. Since it prevents risk factors from appearing
in the first place, major savings in health care costs can be realized by the development
of population-targeted policies that promote improvement of the social milieu as
compared to the development of state-of-the-art treatment and prevention programs.

Primordial prevention measures include legislation of national policies and


development of socio-economic programs that promote healthy lifestyle and discourage
high risk behavior. An example is Republic Act 9211, also known as the Tobacco
Regulation Act of 2003, which is an omnibus law regulating smoking in public places,
tobacco advertising, promotion and sponsorship, and sales restrictions. This law was
recently reinforced with the passing of the Graphic Health Warnings Law, Republic Act
10643, which regulates the packaging and labeling of tobacco products. These are
primordial prevention measures aimed at smoking, a major risk factor to numerous non-
communicable diseases.

II. PRIMARY PREVENTION:


Primary prevention is accomplished in the pre-pathogenesis period of the natural
history of disease, by measures designed to promote general optimum health or by
specific protection of man against disease agents or the establishment of barriers against
agents in the environment.

Primary prevention aims to prevent disease or injury before it ever occurs. This
is done by preventing exposures to hazards that cause disease or injury, altering
unhealthy or unsafe behaviors that can lead to disease or injury, and increasing resistance
to disease or injury should exposure occur.

A. Health Promotion: Promotion of health in the positive sense includes


measures and procedures, which are not generally directed at any particular
disease or disorder, but serve to provide general health and well-being. These
include the following:
 health education in the fundamental facts of health and disease, including
family life education
 good standards of nutrition
 inculcation of healthful living habits, including attention to personality
development and avoidance of fatigue as much as possible
 adequate housing recreations and agreeable working conditions
 improvement and protection of water supply systems
 improvement of environmental sanitation

B. Specific Protection: This is prevention in its conventional sense and


comprises of measures applicable to a particular disease or group of diseases in
order to intercept the cause of disease before they involve man. These include
the following:
 plans for routine specific immunization and use of booster doses at most
effective periods (i.e., National Immunization Program)
 selective immunizations based on exposure or potential exposure
 good personal hygiene
 proper isolation and quarantine when indicated
 proper handling of vehicles of transmission (water, food, etc.)
 concurrent and terminal disinfection when indicated (chlorination of water
supply, etc.)
 satisfactory vector control
 other environmental sanitation measures

III. SECONDARY PREVENTION:


As soon as the disease process is detectable, early in pathogenesis, secondary
prevention may be accomplished by:

Early Diagnosis and Prompt Treatment: The obvious objectives of early


diagnosis and prompt treatment are first, to prevent spread to others if disease is
communicable; second, to cure or arrest the disease process in order to prevent
complication or sequelae; and third, to prevent prolonged disability. This level of
prevention includes:
 case finding by surveys and selective examinations
 use of all available laboratory procedures
 use of consultant specialists in communicable diseases
 adequate identifications of cases
 examination of contacts

This level of prevention can be undertaken at various levels:


 in the general population or in an age specific population
 in captive groups, such as school children, jail inmates, and industrial
workers
 in a hospital or clinical setting

Secondary prevention aims to reduce the impact of a disease or injury that has
already occurred. This is done by detecting and treating disease or injury as soon as
possible, to halt or slow its progress, encouraging personal strategies to prevent re-injury
or recurrence, and implementing programs to return people to their original health and
function to prevent long-term problems.
IV. TERTIARY PREVENTION:
As the process of pathogenesis progresses, it is still possible to accomplish
prevention by what might be termed as corrective therapy or tertiary prevention, which
essentially consists of:

A. Disability Limitation: Specific protection may not always be possible because


of gaps in knowledge or the failure or inability to utilize existing knowledge of early
preventive measures. This level provides for the prevention or delaying of the
consequences of clinically advanced diseases. The main goal is to provide relief
to the affected individual so that a total handicap is prevented. This includes:
 complete therapy
 hospitalization when indicated
 use of home nursing services (i.e., palliative medicine and hospice care)

B. Rehabilitation: This is more than the stopping of the disease process; it is


also the prevention of complete disability after anatomic changes are more or less
stabilized. Its positive objective is to return the affected individual to a useful
place in society and make maximum use of his remaining capacities and includes:
 hospitalization and work therapy in hospitals
 public education to utilize the rehabilitated
 selective placement

Tertiary prevention aims to soften the impact of an ongoing illness or injury that
has lasting effects. This is done by helping people manage long-term, often-complex
health problems and injuries (e.g., chronic diseases, permanent impairments) in order to
improve as much as possible their ability to function, quality of life and life expectancy.

V. QUATERNARY PREVENTION:
Quaternary prevention is defined as actions taken to identify a patient or a
population at risk of over-medicalization, to protect them from invasive medical
interventions and provide for them care procedures which are scientifically and medically
acceptable. Medicine increasingly focuses on the problems that result from an excess of
medical care, in particular over-screening and over-diagnosis. Quaternary prevention
describes the protection of patients from diagnostic tests, interventions and treatments
that offer no benefit for over-all morbidity or mortality for the individual, and may cause
physical or psychological harm. It includes the protection of patients from misled well-
meaning doctors and from a system in which the commercial interests of pharmaceutical
and diagnostic companies, and governments working in a marketized model of health
care, that can distort care, medicalize normal life and waste resources.

Quaternary prevention provides a complex but necessary approach oriented to


provide person-focused care, promote equity in healthcare, prevent over-diagnosis,
unnecessary interventions, and avoid harm; in other words, to humanize medicine. All
the efforts within this global movement combine ethical sustainability with critical
thinking, to oppose the vision of health as a commodity.
Some of the ways quaternary prevention are practiced are the construction of
hospital antibiograms, a periodic summary of antimicrobial susceptibilities of local
bacterial isolates submitted to the hospital's clinical microbiology laboratory, to avoid the
indiscriminate use of antibiotics; and the development of clinical practice guidelines that
aid clinicians in decision-making that is based on evidence provided by existing literature
and extensive research.

REFERENCES:
 Dizon JJ. Epidemiology and Disease Control (Communicable Disease), 3 rd
Edition, Manila, Philippines, 1986
 Gupta MC and Mahajan BK. Textbook of Preventive and Social Medicine, 4th
Edition, New Delhi, India, 2007.
 Ursoniu S. Lecture on Primordial Prevention, University of Pittsburgh.
 Pandve HT. Quaternary Prevention: Need of the Hour. J Family Med Prim
Care. 2014 Oct-Dec; 3(4): 309–310.
 World Organization of National Colleges, Academies and Academic Associations of
General Practitioners / Family Physicians. WONCA Special Interest
Group: Quaternary Prevention and Over-Medicalization.
http://www.globalfamilydoctor.com/groups/SpecialInterestGroups/Quaternary
Prevention.aspx

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