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Health promotion and disease prevention_2019.pptx
1. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
HEALTH PROMOTION AND
DISEASE PREVENTION
Training developed by: Vincent Cubaka
Lecturer: Dr Claudine Abibeshya
2. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
What is the difference between
health promotion and disease
prevention?
3. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
PREVENTION
The goals of medicine are to:
› Promote health
› Preserve health
› Restore health when it is impaired
› Minimize suffering and distress
These goals are embodied in the word
“Prevention”
[Zorana Gledovic in Encyclopedia of Public Health. 2 Vol,2008]
4. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
PREVENTION
Actions aimed at:
o Eradicating
o Eliminating
o Minimizing the impact of disease and disability
o Retarding the progress of the disease and disability
[Zorana Gledovic in Encyclopedia of Public Health. 2 Vol,2008]
5. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
PREVENTION LEVELS
Primordial prevention
Primary prevention
Secondary prevention
Tertiary prevention
Quaternary prevention
prevents the penetration
of risk factors into the population
avoids the development of disease
diagnose and treat an existing
disease in its early stages to avoid significant morbidity
reduce the negative impact of established disease
by reducing disease-related complications
activities that mitigate or avoid the consequences of
unnecessary or excessive interventions in HS
6. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
PREVENTION LEVELS
Doctor
Findings No findings
Patient
Symptom Tertiary prevention Quaternary
prevention
(also with findings)
No
symptom
Secondary
prevention
Primary prevention
7. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
DETERMINANTS OF PREVENTION
o Knowledge of causation
o Dynamics of transmission
o Identification of risk factors
and risk groups
8. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
DETERMINANTS OF PREVENTION
o Early detection
o Prophylactic treatment
measures
o An organization
o Continuous evaluation
9. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
PREVENTABLE CAUSES OF DISEASE
o Biological factors and Behavioral Factors
o Environmental factors
o Immunologic factors
o Nutritional factors
o Genetic factors
o Social factors and Spiritual factors
BEINGS
10. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
Activities that prevent the penetration of risk
factors into the population by intervening to stop
the appearance of the risk factors -Strasser, 1978
PRIMORDIAL PREVENTION
11. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
PRIMARY PREVENTION
o Action taken prior to the onset of disease, which removes
the possibility that the disease will ever occur
o May be accomplished by measures of “Health promotion”
and “specific protection”
12. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
HEALTH PROMOTION
The process of enabling
people to increase control
over the determinants of
health and thereby improve
their health” -WHO 2005-
13. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
Health education
Environmental modifications
Nutritional interventions
Life style and behavioral changes
Immunization and seroprophylaxis
Chemoprophylaxis
Use of specific nutrients or supplementations
Protection against occupational hazards
Safety of drugs and foods
Control of environmental hazards,
e.g. air pollution
Primary prevention
Specific protection
Health promotion
14. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
APPROACHES FOR PRIMARY PREVENTION
o Population (mass) strategy
o High -risk strategy
15. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
POPULATION (MASS) STRATEGY
o Directed at the whole population irrespective of
individual risk levels
o Directed towards socio-economic, behavioral
and lifestyle changes
16. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
HIGH-RISK STRATEGY
o Aims to bring preventive care to individuals at special risk
o This requires detection of individuals at high risk by the
optimum use of clinical methods
17. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
SECONDARY PREVENTION
o “ Action which halts the progress of a disease at its
incipient stage and prevents complications.”
o The specific interventions are:
o Early diagnosis
o Adequate treatment
18. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
All the measures available to reduce or limit
impairments and disabilities, and to promote the
patients’ adjustment to irremediable conditions
TERTIARY PREVENTION
19. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
TERTIARY PREVENTION
o It is used when the disease process has advanced beyond
its early stages.
o Intervention that should be accomplished in the stage of
tertiary prevention are:
o Disability limitation
o Rehabilitation
20. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
Action taken to identify patient at risk of
overmedicalisation, to protect him from new
medical invasion, and to suggest to him
interventions, which are ethically acceptable.
-Jamoulle & Roland, 1986
QUATERNARY PREVENTION
“Primum non nocere”
21. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
LET’S PLAY
Match the following statements with the type of prevention. Each option
may be selected once, more than once, or not at all.
o Prescribing insulin to a diabetic patient
o Recommending regular physical activity to a patient with no known
medical problem
o Vaccinating a health care worker against hepatitis B
o Giving isoniazid for 1year to a 28-year-old medical student with a
positive tuberculin skin test
22. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
Disease
Impairment
Disability
Handicap
OTHER RELATED CONCEPTS
23. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
Any loss or abnormality of
psychological, physiological or
anatomical structure or function
IMPAIRMENT
24. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
Any restriction or lack of ability to
perform an activity in the manner or
within the range considered normal
for the human being
DISABILITY
25. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
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 (depending on age, sex, social and
cultural factors) for that individual
HANDICAP
26. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
The combined and coordinated use of medical,
social, educational, and vocational measures for
training and retraining the individual to the highest
possible level of functional ability
REHABILITATION
27. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
CONTROL, ELIMINATION AND
ERADICATION
28. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
CONTROL
o The incidence of disease
o The duration of disease and consequently the risk of
transmission
o The effects of infection, including both the physical
and psychosocial complications
o The financial burden to the community
29. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
CONTROL
o Control activities focus on primary prevention or
secondary prevention
o Most programs combine both
30. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
DISEASE ELIMINATION
o Elimination: interruption of transmission of disease
o E.g.: elimination of measles, polio and diphtheria
o Regional elimination: important precursor of eradication
31. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
DISEASE ERADICATION
o Eradication literally means to "tear out by roots".
o It is the process of “Termination of all transmission
of infection by extermination of the infectious agent
through surveillance and containment”.
32. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
DISEASE ERADICATION
o Eradication is an absolute process, an "all or none"
phenomenon, restricted to termination of an infection from
the whole world.
o It implies that disease will no longer occur in a population.
o To-date, only one disease has been eradicated, that is…?
33. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
SMALLPOX
34. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
SMALLPOX
35. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
TAKE HOME MESSAGE
o Prevention through it different levels should be the main
aim of health care provision
o Health promotion is part of Primary prevention and allow
people to get control of SDH to improve health
o Important to understand the difference between impair
ment, disability and handicap
o Important to understand the difference between control,
elimination and eradication
36. SCHOOL OF MEDECINE AND PHARMACY
UNIVERSITY OF RWANDA
UR|CMHS ur.ac.rw
REFERENCES
o Kirch, Wilhelm (Ed.) 2008, Encyclopedia of Public Health. 2 Vol.
o JF Jekel, Epidemiology, Biostatistics, and Preventive Medicine, 1996
o Davidson, The public health development theory of four stages of prevention, 2011.
o Pandve HT. Changing concept of disease prevention: From primordial to quaternary .
Arch Med Health Sci 2014;2:254-6
o http://phprimer.afmc.ca/Part1-TheoryThinkingAboutHealth/ Chapter4 Basic Concepts
In Prevention Surveillance And Health Promotion/The stages of prevention [Last acces
sed on 2014 Nov 16]
Discuss in pairs for 3 minutes
Then some groups will give their
differentiation
Embodied=Exemplified, personified.
Prevention is defined as all actions…
-…or if none of these are feasible, retarding the progress …
Exemples and numbers in Rwanda.
The concept of prevention is best defined in the context of levels, traditionally called primary, secondary and tertiary prevention. A fourth level, called primordial prevention, was later added and now we are more and more talking about quaternary prevention. Different definition are found in public text book from different authors and schools.
Primordial prevention describe strategies intend to…
Primary prevention describes all activities aiming to avoids… Most population-based health promotion activities are primary preventive measures.
3. Secondary prevention aims at early diseases detection to prevent its progression
4. Tertiary prevention: Are methods to reduce negative impact of extant disease by restoring function and reducing disease‐related complications. (returning of a patient to a status of maximum usefulness with a minimum risk of recurrence of the disorder)
5. Quaternary prevention is a set of health activities…
Another way of approaching the levels of prevention:
We should think about the need for…if patient has… and doctor get…
Successful prevention depends upon:
a knowledge of causation,
dynamics of transmission,
identification of risk factors and risk groups, E.g EBOLA
Successful prevention depends upon:
-availability of or early detection, prophylactic treatment measures
an organization for applying these measures to appropriate persons or groups, and
continuous evaluation
In 1978 Strasser coined the term ‘primordial prevention’ to denote:…
Eg. Discouraging children from adopting harmful lifestyles . The main intervention is through individual and mass education. This concept can overlaps with health promotion.
-Primary prevention can be defined as the …
-It signifies…
-Primary prevention may be.…
Health promotion is…
…Bangkok Charter for Health Promotion in a Globalized World
OR “The combination of educational and ecological supports for actions and conditions of living conducive to health.” (Green & Kreuter, 1999)
Primary prevention is achieved by….
The WHO has recommended the following approaches for the primary prevention of chronic diseases where the risk factors are established…
-“Population strategy" is…
-Thus…
-For example…studies have shown that even a small reduction in the average blood pressure or serum cholesterol of a population would produce a large reduction in the incidence of cardiovascular disease
The high -risk strategy …
E.G
TB: WHO strategies of intensification of case detection, especially of HIV patient and exposed patients.
Children immunization.
Malaria: use of bed nets went from women and children to all the population
Vaccine aiginst HPV went from girls (9-26 ys) to boys.
-It is defined as … incipient=embryonnic,emmerging
-early diagnosis -e.g. screening tests, and case finding programs….-
The earlier the disease is diagnosed, and treated the better it is for prognosis of the case and in the prevention of the occurrence of other secondary cases.
It is defined as…
The quaternary prevention, concept developped by a Belgian general practitioner called Marc Jamoulle…
2. This term describes….
When talking about tertiary prevention, there are some others concept you should be familiar with: ….and rehabilitation.
The quaternary prevention, concept developped by a Belgian general practitioner called Marc Jamoulle…
2. This term describes….
The quaternary prevention, concept developped by a Belgian general practitioner called Marc Jamoulle…
2. This term describes….
The term disease control describes all operations aimed at reducing…
Between control and eradication, an intermediate goal has been described, called "regional elimination"
The term "elimination" is used to describe interruption of transmission of disease, as for example, elimination of measles, polio and diphtheria from large geographic regions or areas
-E.g.: elimination of measles, polio and diphtheria from large geographic regions or areas
- Regional elimination is now seen as an ….
tear out by roots=tirer/arracher par les racines
To-date, only one disease has been eradicated, that is smallpox (variole). Eradicated in 1979 through vaccination.
Smallpox was an infectious disease caused by one of two virus variants, Variola major and Variola minor. The last naturally occurring case was diagnosed in October 1977 and the World Health Organization (WHO) certified the global eradication of the disease in 1980.
To-date, only one disease has been eradicated, that is smallpox (variole). Eradicated in 1979 through vaccination.
Smallpox was an infectious disease caused by one of two virus variants, Variola major and Variola minor. The last naturally occurring case was diagnosed in October 1977 and the World Health Organization (WHO) certified the global eradication of the disease in 1980.
To-date, only one disease has been eradicated, that is smallpox (variole). Eradicated in 1979 through vaccination.
Smallpox was an infectious disease caused by one of two virus variants, Variola major and Variola minor. The last naturally occurring case was diagnosed in October 1977 and the World Health Organization (WHO) certified the global eradication of the disease in 1980.
