The three levels of prevention in healthcare encompass primary prevention to prevent the onset of disease, secondary prevention to detect disease early and prevent its progression, and tertiary prevention to manage and treat existing conditions to prevent further complications.

1. Levels of
Prevention
Prepared by: Associated Professor Dr Khushhal
Farooqi
2023

2. 6/15/2023 Kandahar University, faculty of Medicine, 3rd class 2

3. 6/15/2023 Kandahar University, faculty of Medicine, 3rd class 3
• Prevention is about avoiding disease before it starts.
• It has been defined as the plans for, and the measures
taken, to prevent the onset of a disease or other health problem
before the occurrence of the undesirable health event.
• Prevention includes a wide range of activities — known as
“interventions” — aimed at reducing risks or
threats to health.
Definition of Prevention

4. PREVENTION:
Cornerstone
of public
health
Levels of prevention
• Primary prevention
• Secondary prevention
• Tertiary prevention
Each of the three approaches has an important role
to play in disease prevention.
However, upstream approaches, e.g., primary
prevention, generally tend to be cheaper and more
efficient, and they entail lower morbidity and
mortality rates.
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• In the primary level are "Health Promotion" and "Specific Protection."
• At the secondary level of prevention, the available intervention is "Early
Diagnosis and Treatment,"
• At the tertiary level of prevention, the interventions are "Disability Limitation“
and "Rehabilitation."
"A public health intervention is any effort or policy that
attempts to improve health on a population level.
THE "INTERVENTIONS"

6. Primary Prevention Level
Primary prevention includes all measures of prevention that are undertaken
during the phase of pre-pathogenesis (phase of susceptibility), before the
disease process has had onset. Primary prevention involves two types of
interventions: health promotion and specific protection.
6/15/2023 Kandahar University, faculty of Medicine, 3rd class 6

7. Primary Prevention Level…
Examples include:
• legislation and enforcement to ban or control the use of hazardous products
(e.g. asbestos) or to mandate safe and healthy practices (e.g. use of
seatbelts and bike helmets)
• education about healthy and safe habits (e.g. eating well, exercising regularly,
not smoking)
• immunization against infectious diseases.
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8. Primary Prevention Level
Health Promotion
Health promotion includes all steps undertaken to improve the level of general health and well-being so
that the conditions for the initiation of the disease process are prevented. However, these steps are not
specific for any disease or a group of diseases. The actions include
• Improvement in the overall socioeconomic status of the population,
• Health education,
• Feeding programs for mothers and children,
• Promotion of breastfeeding,
• Promotion of small family norms,
• Education and motivation for healthy lifestyle, and such similar measures.
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9. The health promotional approach improves the general
health so that prevention of several diseases is aimed at instead
of a single disease. For example, when we promote
breastfeeding among children, we are trying to
• Prevent general malnutrition,
• Vitamin A deficiency,
• Providing antibodies against various diseases,
• Preventing diarrheal diseases (because artificial feeding carries the risk of
infection).
It also has numerous benefits for the mother, such as
• Reducing the risk of breast cancer and
• Providing a unique bonding experience between the mother and baby
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Primary Prevention Level…

10. Health Promotion Strategies: (“Every Big Person Should Care When People Collaborate”.)
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Primary Prevention Level…
• Education and Awareness: Campaigns to increase knowledge about healthy behaviors, risks and benefits.
• Behavioral Interventions: Promote healthy lifestyle habits such as diet and exercise.
• Public Policy Changes: Create environments that support health – e.g., smoke-free laws, bike lanes, green
spaces.
• Social Media: Disseminate health information and reach targeted populations.
• Community-Based Interventions: Engage local organizations and stakeholders to promote health and
well-being.
• Worksite Wellness Programs: Offer incentives and support healthy choices in the workplace.
• Personalized Approaches: Target individuals at high risk for certain diseases or conditions.
• Collaborations: Between healthcare systems and community resources to provide coordinated care and
support for patients beyond traditional medical interventions

11. Specific Protection
Specific protection includes measures to prevent the initiation of a specific disease
or a group of diseases.
Examples include
• Immunization to protect against specific diseases,
• Fortification of foods with specific nutrients (as salt with iodine),
• Use of condoms for protection against sexually transmitted diseases (STIs),
• Use of chemoprophylactic drugs for protection against particular diseases (such
as malaria, meningococcal meningitis, plague, and tuberculosis), and
• Use of helmets to protect head from injuries.
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12. Secondary Prevention Level
Includes all actions undertaken at the stage of early pathogenesis (asymptomatic
disease) a view to halt the progress of disease at its earliest, emerging stage by
"early diagnosis and prompt treatment."
It is like stamping out a fire when it has just started rather than calling the fire
brigade after the fire has become voluminous.
• The affected person is not aware of any signs or symptoms and
• The routine clinical methods may also not be able to detect a disease at this stage;
since the disease process is in the very preliminary stage. However, by using
special procedures we can uncover a disease at such early stages.
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13. Secondary Prevention Level…
The goal of secondary prevention is to reduce the impact of a disease or condition
by
• Detecting it early,
• Minimizing the complications, and
• Reducing the severity of symptoms.
It is especially important for individuals who are at high risk of developing certain
diseases or conditions such as cancer, diabetes, or heart disease.
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Examples of secondary prevention include screening programs such as mammography to detect
breast cancer and dual x-ray absorptiometry (DXA) to detect osteoporosis

14. Tertiary Prevention Level
Tertiary prevention includes all measures undertaken when the disease has become
clinically manifest or advanced, the aims
• Preventing or delaying death,
• Reducing or limiting the impairments and disabilities,
• Minimizing suffering, and
• Promoting the subject's adjustment to irremediable conditions.
Tertiary prevention has two types of inbuilt interventions:
• Disability limitation and
• Rehabilitation.
6/15/2023 Kandahar University, faculty of Medicine, 3rd class 14

15. Tertiary Prevention Level…
Disability Limitation
Disability limitation includes all measures
undertaken to prevent the occurrence of
• Further complications,
• Impairments,
• Disabilities and
• Handicaps, or
• Even death.
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16. Tertiary Prevention Level…
Disability Limitation: For example, let us say
• an agricultural worker gets acute myocardial infarction. This is the disease.
• Due to this disease, he would have necrosis of a part of the myocardium, inadequate perfusion of
the myocardium, and inadequacy in the pumping action of the heart with a compromise in the
oxygenation of the blood. These are the "impairments" due to the disease.
• Due to these impairments, he will not be able to undertake hard manual labor, which an otherwise
healthy male of his age would have undertaken—this is the disability resultant to the impairment.
• Finally, because of this disability, he will lose his job of an agricultural worker and, hence, will not
be able to earn adequate livelihood—this is the handicap, I consequent to the disability.
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17. Tertiary Prevention Level…
Rehabilitation
For example, when a patient is treated for Hansen’s disease, it is not simply enough to
treat the patient with the recommended antibiotic regime and then forget about the patient.
A lot still needs to be done.
• The patient would be having claw hands and would need the hands to be made as near-normal as possible by
corrective surgery; so that he can work productively as well undertake the daily activities of life.
• The patient also needs to be trained in some vocation so that he can make a living.
• The patient's family and the society must be educated to accept this patient as a normal human being and not
as one who has been cursed by the Gods.
• The patient himself would be emotionally weak and labile and would need to be emotionally supported.
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18. Tertiary Prevention Level…
Rehabilitation
All these activities come under the purview of "rehabilitation" (re : restore into, habitat = the original home or
environment of the person).
Rehabilitation is undertaken in four dimensions:
1-Medical Rehabilitation: This is done through medical/ surgical procedures to restore the anatomy and
physiological functions to as near-normal as possible.
2-Vocational Rehabilitation (
‫حرفوی‬
) : This includes steps involving training and education to enable the
person to earn a livelihood.
3- Social rehabilitation: This involves steps for restoration of the family and social relationships.
4. Emotional and psychological rehabilitation: This involves steps to restore the confidence and personal
dignity.
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19. Kandahar
University,
faculty
of
Medicine,
3rd
class
6/15/2023 19

20. Primordial Prevention (Target social and economic policies effecting health )
• Primordial prevention aims to prevent the emergence of risk factors that lead to disease by creating optimal
living and lifestyle conditions. (This approach ensures that conditions leading to
potential health risks are addressed proactively.)
• Primordial prevention targets the underlying stage of natural disease by targeting the
underlying social conditions that promote disease onset.
For example,
• By eliminating the availability of cigarettes and even the production of tobacco,
we are effectively eradicating the factors that give rise to pre-pathogenesis.
• Improving access to an urban neighborhood to safe sidewalks to promote
physical activity; this, in turn, decreases risk factors for obesity, cardiovascular
disease, type 2 diabetes, etc.
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21. Quaternary Prevention
Quaternary prevention is a recently
emerging concept and is defined as
"steps taken to prevent, decrease,
and/or alleviate the harm caused by
health activities. "
while health activities generally
produce benefits, they can also cause
harm.
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22. Quaternary prevention is the avoidance of unnecessary medical activity, keeping in mind the classic medical
principle of "first, do no harm.“
Primum non nocere—first do no harm—is a fundamental principle to all physicians originating from the
Hippocratic Oath, reminding us that restraint might be the most appropriate not to harm the patient in the case of
great uncertainty despite our best intentions.
Examples of quaternary prevention include:
• Avoidance of unnecessary antibiotics,
• Avoidance of unnecessary screening for disease without any foundation, and
• Avoidance of invasive clinical procedures when they are not required or are of no proven efficacy;
in short, avoidance (i.e., prevention) of any healthcare activity which is either not evidence based or not
required in the given clinical situation.
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Quaternary prevention

23. • Monger :broker, dealer — usually used in combination; a person who attempts to spread something that is usually petty or discreditable —
usually used in combination (e.g., warmonger) . Source: Merrian-Webster.com
• Disease mongering is a disapproving term for the practice of widening the diagnostic boundaries of illnesses and
aggressively promoting their public awareness in order to expand the markets for treatment. or
• Disease mongering is the promotion of pseudo-diseases by the pharmaceutical industry aiming at economic benefit.
It can take many forms,
• Including framing risk factors as diseases,
• Portraying mild problems as severe pathology,
• Widening existing definitions and constructing whole new categories of medical illness.
The concern is that by transforming more and more of the ups and downs of ordinary life into the signs and symptoms of treatable
conditions, we may be producing much iatrogenic illness, and wasting many resources.
Selling Sickness: how the world’s biggest pharmaceutical companies are turning us all into patients (Moynihan & Cassels, 2005)
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Disease Mongering (Pseudo-Disease Promotion)…

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The key difference between disease mongering and overmedicalization is that
disease mongering involves creating a demand for medical interventions
through the exaggeration or creation of medical conditions, while
overmedicalization involves the inappropriate use of medical interventions for
conditions that do not require them.

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