1) Prevention aims to promote health and safety in communities by slowing the onset of disease through measures like health education, vaccinations, and early diagnosis. 2) There are four levels of prevention: primordial focuses on whole populations, primary targets risk factors, secondary detects disease early, and tertiary manages existing conditions. 3) Successful prevention requires understanding disease causation and risk factors, implementing prophylactic measures for at-risk groups, and continuous evaluation of prevention programs. Going "upstream" to address root causes is most effective.

1. NIMRA ZAMAN
PHARM.D (2011-15) MPH (2017-19)
LIAQUAT UNIVERSITY OF MEDICAL AND HEALTH SCIENCES,
JAMSHORO.(LUMHS).

2. DEFINITION OF PREVENTION:
The Management Of Those Factors That
Could Lead To Disease So As To Prevent The
Occurrence Of the Disease.
- Mosby dictionary
Any measure such as early
information campaigns,
vaccinations , early diagnosis ,
intended to limit health
related risks .

3. Prevention is like a speed bump to promote
health and safety in communities
“slow down the age of onset of disease”
 The goals of healthcare professionals 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“

4. •Over the last 50 years prevention has changed from the use
of scare tactics, information and drug education only…To a
science based approach.
“A multidisciplinary field devoted to the scientific
study of the theory, research, and practice related to the
prevention of social, physical, and mental health
problems, including etiology, epidemiology, and
intervention”.*
*IOM “Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities” pg xxvii

5. Through the lens of a public health model for
change; using prevention science, we are laying
the foundation for community change
CADCA: Beyond the Basics, The Coalition Impact Environmental Strategies pg
4

6.  Primordial ,Primary, secondary and tertiary prevention
are the terms that map out the range of interventions
available to health experts
 Prevention includes a wide range of activities
— known as “interventions” — aimed at
reducing risks or threats to health.
You might have heard researchers and health experts talk
about the categories of prevention: primordial , primary,
secondary and tertiary. What do they mean by these terms?

7. Why is prevention important?
“
• We buy software to protect/prevent our computers from viruses.
•But what about washing our hands to prevent the spread of
disease.
•What about vaccinating our children to prevent sickness.
•what should we do to prevent tobacco use, alcohol abuse, RTAs and
illicit drug use, diabetes , hypertension etc?

8. Preventable Causes of Disease
BEINGS
Biological factors and Behavioral Factors
Environmental factors
Immunologic factors
Nutritional factors
Genetic factors
Services, Social factors, and Spiritual factors
[JF Jekel, Epidemiology, Biostatistics, and Preventive Medicine, 1996]

9. LEVELS OF PREVENTION
The concept of prevention
is best defined in the
context of levels,
traditionally called
primary, secondary and
tertiary prevention.

10. 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
A fourth level, called primordial prevention, was later added

11. In modern day, the concept of prevention has become broad-
based. It has become customary to define prevention in terms of
four levels:
Primordial prevention
Primary prevention
Secondary prevention
Tertiary prevention
Underlying
conditions leading to
causation
Total
population/selected
groups
Specific causal factor Total
population/selected
groups/individuals
Early stage of disease Patient
Last stage of disease
(treatment,
rehabilitation)
patient

12. PRIMORDIAL PREVENTION
“It is the prevention of emergence of
risk factors in populations, 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).
.
INTERVENTIONS:
The main intervention in primordial
prevention is through individual and mass
health education.

13. 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”
or
“It aims to prevent disease or injury before it ever occurs. “
 This is done by preventing exposures to hazards that cause disease or
injury, altering unhealthy or unsafe behaviours that can lead to disease
or injury, and increasing resistance to disease or injury
 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.

14. Primary prevention
Specific protectionHealth promotion
Achieved by
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

15.  Health education to improve healthy habits and health consciousness in the
community.
 Improvement in nutritional standards of the community.
 Healthful physical environment (Housing, watersupply, excreta disposal,etc.,)
 Good working condition
 Mariage Counselling
 Periodic Selective examination of risk population.
General Health promotion
Health education Environmental modifications
Nutritional interventions Lifestyle and behavioural changes.
Specific protection:
Use of Specific immunization (BCG, DPT,MMR vaccines)
Chemoprophylaxis (tetracycline for Cholera, dapsone for Leprosy, Chloroquine for
malaria,etc.,)
Use of specific nutrients (vitamin A for Children, ironfolic acid tablets for Pregnant
mothers) Protection against accidents (Use of helmet, seatbelt,etc.,)
Protection against occupational hazards.
Avoidance of allergens.
Protection from air pollution.

16. Approaches for Primary Prevention
 The WHO has recommended the following
approaches for the primary prevention of chronic
diseases where the risk factors are established:
 a. Population (mass) strategy
 b. High -risk strategy

17. Primary interventions
(mass) Strategy:
 It is directed at the whole population
irrespective of an individual risk levels.
High- risk Strategy:
 It aims to bring preventive care to individuals at
special risk.
 This requires detection of individuals at high risk by
the optimum use of clinical methods.

18. 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.
SECONDARY PREVENTION:
“The action which halts or slow the progress of a
disease at its incipient stage and prevents complications”.
Examples include:
regular exams and screening tests to detect disease in its earliest stages (e.g.
mammograms to detect breast cancer) daily, low-dose aspirins and/or diet and
exercise programs to prevent further heart attacks or strokes

19. Secondary modes of interventions
 Individual and mass case-finding measures.
 Screening surveys(urine examination for diabetes,etc.,
 Selective examination

20. TERTIARY PREVENTION
• 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
This is done by helping people manage long-term, often-complex
health problems and injuries (e.g. chronic diseases, permanent
impairments) in order to improve as much as possible their ability
to function, their quality of life and their life expectancy.
Examples include : cardiac or stroke rehabilitation programs, chronic disease
management programs (e.g. for diabetes, arthritis, depression, etc.)
support groups that allow members to share strategies for living well
vocational rehabilitation programs to retrain workers for new jobs when they
have recovered as much as possible.

21. 3) MODES OF INTERVENTION:
Disability
limitation
REHABILITATION:
Disease
Impairment
Disability
Handicap
Rehabilitation
Medical
rehabilitation
Vocational
rehabilitation
Social
rehabilitation
Psychological
rehabilitation

22. • Impairment is “any loss or
abnormality of psychological,
physiological or anatomical structure
or function.”
• Disability is “any restriction or
lack of ability to perform an activity in
the manner or within the range
considered normal for the human
being.”
• Handicap is termed as “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, and social and cultural factors)
for that individual.”
•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).

24.  Going “upstream”
 For many health problems, a combination of primary, secondary and tertiary
interventions are needed to achieve a meaningful degree of prevention and
protection. However, as this example shows, prevention experts say that the
further “upstream” one is from a negative health outcome, the likelier it is that
any intervention will be effective.
 To help explain the difference, take this example. Let’s say you are the mayor of a town
near a swimming hole used by kids and adults alike. One summer, you learn that citizens
are developing serious and persistent rashes after swimming as a result of a chemical
irritant in the river. You decide to take action.
 If you approach the company upstream that is discharging the chemical into the river
and make it stop, you are engaging in primary prevention. You are removing the
hazardous exposure and preventing rashes in the first place.
 If you ask lifeguards to check swimmers as they get out of the river to look for signs of a
rash that can then be treated right away, you are engaging in secondary prevention. You
are not preventing rashes, but you are reducing their impact by treating them early on so
swimmers can regain their health and go about their everyday lives as soon as possible.
 If you set up programs and support groups that teach people how to live with their
persistent rashes, you are engaging in tertiary prevention. You are not preventing rashes
or dealing with them right away, but you are softening their impact by helping people
live with their rashes as best as possible.

25. 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

26. 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

28.  The World Health Organization (WHO) recommends
and encourages the member states that all countries should
spend at least 5% of their GDP on health in order to meet
the targets set by the nations.
 More than 80% of world population suffers from over 90%
Of total burden of diseases.
This huge population depends on just 11% of total health
expenditure, a disparity and inequity mentioned in the
world development report by the World Bank(2007)

29.  In case of Pakistan, traditionally, we spent lowest on development in
general and health and education in particular.
 A large sum of the budget is being spent on the curative care and hospital
cost in a scenario where one-third of the population in Pakistan lives below
the poverty line (US$1) and the health facilities remain widely inaccessible
to the masses.
 The health budget has always been low and stagnant. It has remained
around less than 0.6% Reliance of the country’s healthcare on foreign
funding and a stagnant internal health budget shows a gloomy picture of
the healthcare expenditure.
Pakistan spends 80% of its meager health budget on
tertiary care services, utilized by only 15% of the
population and 15% on primary healthcare services,
used by 80% of the population.

30. Health Systems Challenge
Despite recent investments in community health, in 2010
public health spending by governments at all levels
constituted only about 3% of total health spending
Public Health Spending All Other Health Spending

31.  Everyone - businesses, educators, health care
institutions, government, communities and every
single person- has a role in creating a healthier
nation.
 What will this look like in your community?
Prevention should be woven into all aspects of our
lives, including where and how we live, learn, work
and play.

32. Vision for the
Disease Prevention System
• Healthier
students to
schools
• Healthier workers
to businesses and
employers
• A healthier
population to the
health care system
Improving community
conditions to support
healthy behaviors and
promote preventive
measures will lead to
better management of
disease and will
deliver:
Healthier
People
Lower
Health
Care Costs