This document discusses concepts and modes of intervention for disease prevention. It outlines 5 levels of prevention - primordial, primary, secondary, tertiary, and quaternary. Primary prevention aims to remove the possibility of disease occurring through health promotion and specific protection like immunization. Secondary prevention attempts to detect and treat disease early to stop complications. Tertiary prevention focuses on rehabilitation and limiting disability for diseases that have advanced. The document also discusses determinants of prevention, preventable causes of disease, and strategies for assessing exposure and identifying at-risk populations.

1. Concept & Modes of Intervention for Disease Prevention
Dr. Ankit Chaudhary
Senior Resident
Community Medicine
Dr. RPGMC Kangra at Tanda

2. Introduction
• Actions aimed at eradicating, eliminating or minimizing the impact of disease and
disability, or if none of these are feasible, retarding the progress of the disease and
disability

3. Determinants of Prevention
• Knowledge of causation
• Dynamics of transmission
• Identification of risk factors and risk groups
• Availability of prophylactic or early detection and treatment measures
• Organization for applying these measures to appropriate persons or groups
• Continuous evaluation of & development of procedures applied

4. Preventable Causes of Disease
• Biological factors and Behavioral Factors
• Environmental factors
• Immunologic factors
• Nutritional factors
• Genetic factors
• Services, Social factors, and Spiritual factors

5. Levels of Prevention
Primordial Primary Secondary Tertiary Quaternary

6. Primordial prevention
• Actions & measures that inhibit emergence of risk factors in form of environmental,
economic, social, and behavioral conditions & cultural patterns of living etc.
• Prevention of emergence/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 (e.g. smoking,
eating patterns, physical exercise)

7. Primary Prevention
• Action taken prior to onset of disease, removing possibility that disease will ever occur
• Signifies intervention in the pre-pathogenesis phase of a disease or health problem
• Accomplished by measures of “Health promotion” and “specific protection”
• Health Promotion: Process of enabling people to increase control over the determinants
of health and thereby improve their health

8. Primary Prevention: Modes of Intervention
Primary
Prevention
Health
Promotion
•Health Education
•Environmental Modifications
•Nutritional Interventions
•Lifestyle/Behavioural Changes
Specific
Protection
Immunization/Sero-prophylaxis
Chemo-prophylaxis
Specific Nutrient Supplementation
Occupational Hazard Protection

9. Primary Prevention: Approaches
Population/Mass Strategy
 Directed at the whole population irrespective of individual risk levels
 e.g. studies have shown that even a small reduction in the average BP or serum
cholesterol of a population would produce a large reduction in the incidence of CAD
 Directed towards socio-economic, behavioral and lifestyle changes
High Risk Strategy
 Aims to bring preventive care to individuals at special risk
 Detection of individuals at high risk by the optimum use of clinical methods

10. Secondary Prevention
• Action which halts progress of a disease at its incipient stage and prevents complications
• Attempts to arrest disease process, restore health by seeking out unrecognized disease &
treating it before irreversible pathological changes take place & reverse communicability
of infectious diseases
• Protects others from acquiring infection and thus provide at once secondary prevention
for the infected ones & primary prevention for their potential contacts

11. Secondary Prevention: Modes of Intervention
• Early diagnosis (e.g. screening tests & case finding programs)
• Adequate treatment (Medical & Surgical)

12. Tertiary Prevention
• When the disease process has advanced beyond its early stages
• “All the measures available to reduce or limit impairments & disabilities and to promote
the patients’ adjustment to irremediable conditions.”

13. Tertiary Prevention: Modes of Intervention
• Disability limitation
• Rehabilitation
Stages of Disease Progression
• Impairment is loss or abnormality of psychological/physiological/anatomical structure or
function (loss of foot)
• Disability is restriction or inability to perform an activity in manner or within range
considered normal for the human being (inability to walk)
• Handicap is a disadvantage for a given individual, resulting from an impairment or
disability, that limits or prevents the fulfillment of a role in the community that is normal
for that individual (unemployed)

14. Tertiary Prevention: Rehabilitation
• Combined & coordinated use of medical, social, educational, psychological and
vocational measures for training and retraining the individual to the highest possible
level of functional ability

15. September 22,
2014
15
All levels of prevention can be used to control a single disease process
• BCG Vaccination of newborns (primary prevention)
• Screening and early treating a person with active tuberculosis (secondary prevention)
may prevent transmission to another person (primary prevention)
• In advanced cases of tuberculosis, occupational and social rehabilitation (tertiary
prevention) by modification of working conditions may help to regain the capacity to
earn his livelihood
Examples of uses of levels of prevention

16. Quaternary Prevention
• Action taken to identify patient at risk of overmedicalization, to protect him from new
medical invasion, and to suggest to him interventions, which are ethically acceptable

17. Strategy for Prevention
Assess
Exposure
Identify
Populations
at High
Disease Risk
(based on demography /
family history,
host factors..)
Conduct
Research on
Mechanisms
(including the study of
genetic susceptibility)
Apply
Population-Based
Intervention
Programs
Evaluate
Intervention
Programs
Modify Existing
Intervention
Programs
Epidemiology Division

18. Stages of Disease Prevention
Control Elimination Eradication Extermination