Levels of prevention

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 embodies 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.

Four levels of prevention

In modern day, the concept of prevention has become broad-based. It has become customary to define prevention in terms of four level.

1. Primordial prevention
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention

Primordial prevention

Primordial prevention, a new concept, is receiving special attention in the prevention of chronic diseases. This is primary prevention in its purest sense, that is, 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). 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 "action taken prior to the onset of disease, which removes the possibility that a disease will ever occur".

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. The concept of primary prevention is now being applied to the prevention of chronic diseases such as coronary heart disease, hypertension and cancer based on elimination or modification of risk factors of disease.

Secondary prevention

Secondary prevention can be defined as "action which halts the progress of a disease at its incipient stage and prevents complications". The specific interventions are early diagnosis and adequate treatment. By early diagnosis 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 have taken place; and reverse communicability of infectious diseases. It may also protect others in the community from acquiring the infection and thus provide, at once, secondary prevention for the infected individuals and primary prevention for their potential contacts. The health programmes initiated by governments are usually at the level of secondary prevention.

Tertiary prevention

When the disease process has advanced beyond its early stages, it is still possible to accomplish prevention by what might be called " tertiary prevention". It signifies intervention in the late pathogenesis phase.

Tertiary prevention can be defined as "all measures available to reduce or limit impairments and disabilities, minimize suffering caused by existing departures from good health and to promote the patient's adjustment to irremediable conditions".

Tertiary prevention extends the concept of prevention into fields of rehabilitation.