Dr. Muhammad Tauseef Javed discusses the levels of disease prevention which include primordial, primary, secondary, and tertiary prevention. Primordial prevention aims to avoid risk factors in whole populations through public health policy. Primary prevention reduces risk factors and disease occurrence through interventions targeted at healthy groups. Secondary prevention avoids irreversible damage through detecting and treating disease in pre-clinical phases in high-risk groups. Tertiary prevention aims to avoid disability and restore function in patients with clinical disease.

1. Dr Muhammad Tauseef Javed.
MBBS. DPH,MSc Medical Addm. Dip-Card,
M.Phil, FCPS,PhD
Asct Professor Community Medicine
Services Institute Of Medical Sciences Lahore. Ex-Prof
Umulqurah University Makah KSA

2. level of prevention

3. General Approach to Disease
Prevention

4. Goals 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 embodied in the word "prevention"
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Dr. M. Tauseef Javed SIMS LAHORE

5. Prevention; Definition and Concept
• 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.
• 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.
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6. General Community Medicine
• Designing community based health interventions
• Based on principles of:
• Acceptability
• Affordability
• Accessibility
• Cost effectiveness
• Implementing suitable interventions
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7. Determinants of 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
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8. So 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 embodied in the word "prevention"
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9. Levels of Prevention
Stage of disease Level of prevention Type of response
Pre-disease Primary Prevention Health promotion and
Specific protection
Latent Disease Secondary prevention Pre-symptomatic
Diagnosis and
treatment
Symptomatic Disease Tertiary prevention •Disability limitation for
early symptomatic disease
•Rehabilitation for late
Symptomatic disease
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10. Levels of prevention
Primordial prevention
Primary prevention
Secondary prevention
Tertiary prevention
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11. Primordial
Avoiding appearance
of risk factors
Target is whole
population through
public health policy
Primary
Reducing risk factor
and avoiding disease
occurrence
Targets are healthy
selected groups or
whole population
Secondary
Avoiding
irreversible damage
by detection and
treatment in pre-
clinical phase
Targets are high risk
or selected exposed
groups
Tertiary
Avoiding disability
and restoration of
functions
Targets are patients
in terminal clinical
phase
Health
and
Disease
Spectrum
Positive
Health
Disability/
death
Conceptual Model for Levels of Prevention
Level 1
Level 2
Level 3
Level 4
Susceptibility phase
Un recognized illness
Clinical illness with or without complications
Better Health
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13. Levels of prevention
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Tertiary
prevention
Secondary
prevention
Primary Prevention
Primordial prevention

14. Primordial prevention
• Primordial prevention consists of actions and
measures that inhibit the emergence of risk factors in
the form of environmental, economic, social, and
behavioral conditions and cultural patterns of living
etc.
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15. Primordial prevention (cont.)
• It is the 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).
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16. Primordial prevention (cont.)
• 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
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17. “Genes load the gun.
Lifestyle pulls the trigger”
Dr. Elliot Joslin
Lifestyle Factors
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18. Modes of intervention
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Stage of disease Level of prevention Modes of intervention
Pre-disease Primary Prevention Health promotion and
Specific protection
Latent Disease Secondary prevention Pre-symptomatic
Diagnosis and
treatment
Symptomatic Disease Tertiary prevention •Disability limitation for
early symptomatic disease
•Rehabilitation for late
Symptomatic disease

19. Primary
Prevention
Achieved by Achieved by
Specific
protection
Health
promotion
Nutritional
interventions
Life style and behavioral
changes
Environmental
modifications
Health education
Immunization and seroprophylaxis
chemoprophylaxis
Use of specific nutrients or
supplementations
Safety of drugs and foods
Control of environmental hazards,
e.g. air pollution
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20. WHAT IS HEALTH PROMOTION?
Health promotion is the process of enabling people to
increase control over, and to improve their health.
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Enabling the people to have informed
choices for the behaviors conducive to
health

21. THE PROCESS OF HEALTH PROMOTION
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FOCUS STRATEGIES IMPACT OUTCOMES
Individuals
Groups
Population
Education
counseling
Medical
Empowerment
Social change
Behavioral
educational
change
Social,
economic and
environment
change
Better
Health
Quality of
life

22. Examples
• Awareness of risk factors CHD
• Awareness of benefits of breastfeeding
• Awareness of dangers of bottle feeding
• Nutritional counseling
• Growth monitoring
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24. Specific protection
Specific action taken before the occurrence of a
disease
Examples
• Use of iodized salt
• Polio vaccination
• Use of Rifampicin as prophylaxis for T.B
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26. Objectives of Secondary Prevention
Complete cure and prevent the progression of
disease process.
To prevent the spreads of disease by curing all
the known cases.
To prevent the complications and sequel of
disease.
To shorten the period of disability.
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27. SECONDARY PREVENTION
Prevention in pre-symptomatic phase
Action taken during the disease process
to prevent:
Complications
Physical and mental sufferings
Loss of productivity
Secondary prevention is applicable to only selective
disease not every disease
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28. Diseases suitable for secondary
preventions
• Prolong latent or incubatory phase
• Reversible with suitable intervention
• Suitable community diagnostic techniques available
Examples
 Breast cancer and cervical cancer
 HIV/AIDS
 Coronary heart disease
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29. Secondary prevention dependent on length
of latent phase
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Unrecognized sickness
Mild sickness
-Impairment
-Disability
-Handicap or
death
Unrecognized
sickness
Mild sickness
-Impairment
-Disability
-Handicap or death

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31. (i) Disability Limitation
• To prevent or halt the transition of disease
process from Impairment & Handicap.
• Impairment: any loss or abnormality of
psychological, physiological or anatomic
structure or function.
• Disability: any restriction or lack of ability to
perform an activity in the manner considered
normal for a human being.
• Handicap: disadvantage for a given individual,
resulting from impairment or disability, that limits
or prevents the fulfillment of a role that is normal
for that individual
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32. TERTIARY PREVENTION
All the measures taken to reduce or limit the
Impairment/ disabilities and restoration of functions
Main strategies are:
1. Disability limitation
2. Rehabilitation
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35. Disease Impairment Disability Handicap
Accident Loss of foot
Inability to
walk
unemployment
Concept of impairment, disability and handicap
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36. ACCIDENT
Impairment: Loss of an
anatomical structure
Disability: Lack of ability to
perform an activity
Handicap: Prevents
fulfillment of normal role
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37. Disease - dental caries Impairment – loss of
tooth
Disability – cant talk Handicap – cant socialize
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39. (ii) Rehabilitation
• Rehabilitation is “ 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.”
• Requires cooperation from different sections of
society.
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40. Disability limitation
(Tertiary level prevention)
Actions taken to restore the functionality of the disable
organs
Surgery
Organ transplantation
Plastic surgery
Hearing aid
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41. REHABILITATION
(Tertiary Prevention)
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Rehabilitation is the combine coordinated use of medical,
social, educational and vocational measures for retaining the
individual to highest functional ability
 Medical Rehabilitation
 Vocational Rehabilitation
 Social Rehabilitation
 Psychological Rehabilitation

42. Rehabilitation
Medical
rehabilitation
Vocational
rehabilitation
Social
rehabilitation
Psychological
rehabilitation
Types of Rehabilitation
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43. Cont…
• Medical rehabilitation: (restoration of Bodily
Function).
• Vocational rehabilitation:( restoration of the
capacity to earn a livelihood)
• Social rehabilitation: (restoration of family and
social relationship).
• Psychological rehabilitation: (Restoration of
personal dignity and confidence).
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44. Examples of
Rehabilitation
• Establishing schools for the blind.
• Exercises in neurological disorders
• Prosthetic restoration of lost tooth
• Reconstructive surgery in Leprosy.
• Change of profession for a more suitable one and
modification of life in general in the case of TB,etc.,
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45. Natural History of disease prevention model
Pathogenic
phases
Health
Spectrum
Levels of
Prevention
Modes of
Intervention
Risk factor Wellbeing state
Primordial
prevention
Public health
policies to avoid
risk factors
Pre-pathogenic
phase
Free from
sickness
Primary
prevention
Health promotion
Specific
protection
Early Pathogenic
Phase
Subclinical disease
Secondary
prevention
Pre-symptomatic
detection and
treatment
Late pathogenic
phase
Clinical disease
Tertiary
prevention
Disability
limitation and
Rehabilitation
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46. This is
My
Thank
You
Dance..!
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