Levels of Prevention PDF

Levels of Prevention Dr Emma Gale Public Health Physician/Senior Lecturer Acknowledgement of country Learning Objectives List and describe the different levels of prevention Describe the individual and population approaches to prevention Prevention definition “approaches and activities...

Levels of Prevention Dr Emma Gale Public Health Physician/Senior Lecturer Acknowledgement of country Learning Objectives List and describe the different levels of prevention Describe the individual and population approaches to prevention Prevention definition “approaches and activities aimed at reducing the likelihood that a disease or disorder will affect an individual, interrupting or slowing the progress of the disorder or reducing disability” -WHO Prevention is better than cure.  Levels of Prevention Disease onset Primordial Secondary Prevent risk factor Early disease development – address diagnosis and social determinants management e.g. crowding, lack of access to sanitary water early detection via screen No Disease Asymptomatic Symptomatic Primary Tertiary Manage the risk Optimise disease factors to prevent management and disease onset reduce complications treat promptly and early e.g. high cholesterol, low exercise levels, family history RHD Example Rheumatic Heart Disease Preventable disease of disadvantage and health inequality Important cause of morbidity and mortality in some populations - Aboriginal and Torres Strait Islander people, Maori, and migrants from Pacific nations in Australia An abnormal autoimmune host response to infection with group A strep (GAS) throat or skin infection → ARF Fever, arthritis, carditis, skin changes, raised inflammatory markers Repeated episodes of ARF can cause permanent heart valve damage → RHD Image from: Sore throat and skin sores - client Poster | Rheumatic Heart Disease Australia (rhdaustralia.org.au) Primordial prevention Prevent the development of risk factors Improve the social determinants of health e.g., social, environmental, economic conditions ARF/RHD GAS spreads readily in overcrowded conditions with poor hygiene infrastructure Address social determinants such as housing conditions, crowding, ensuring WASH (water, sanitation, hygiene) facilities, health literacy and education Primary Aim to prevent disease from happening in the first place Manage risk factors ARF/RHD Early recognition and treatment of GAS infections in high-risk patients to prevent development of ARF/RHD Community and clinician education Image from: Stop rheumatic heart disease | Rheumatic Heart Disease Australia (rhdaustralia.org.au) Secondary Early detection and management of a disease that is already occurring to improve outcomes ARF/RHD Early recognition of ARF Long-term monthly antibiotic bicillin injections to prevent subsequent episodes and prevent permanent heart damage Tertiary prevention Optimise management of disease Reduce disability, limit or delay complications or death ARF/RHD Early recognition of RHD Optimise medical management Optimise surgical management Broad approaches to prevention INDIVIDUAL (HIGH RISK) POPULATION Prevention paradox A large number of people exposed to a small risk may generate more cases than a small number exposed to a high risk % population HIGH RISK APPROACH LOW NORMAL HIGH Level of risk Population approach Addresses broad risk factors Useful if risk factor is widespread across population Useful if dose-response relationship (more exposure = more disease/greater risk) Good reach but the effect on each participating individual may not be very significant Individual benefits can be perceived as low Individual Personalised Often preferred by society Easier for health professionals Doesn't address underlying drivers of disease Overall impact relatively low May be more resource intensive Does not address broader issues Economic benefits of prevention Diseases are associated with significant costs to the healthcare system (e.g., hospitalisation is very expensive) Prevention can  Lower direct healthcare costs  Lower costs to the individual  Lower indirect costs to economy due to premature death and years spent in ill health (e.g., time off work, more productive years in the workforce) Obesity (1)  Estimated cost $11.8 billion in 2018  Direct health costs $5.4 billion  Indirect costs to community $6.4 billion  To cover the costs of obesity, each Australian pays an additional $678 in taxes each year  Estimated that every $1 invested in obesity prevention has a return of up to $6 1. Commonwealth of Australia 2022. The National Obesity Strategy 2022-2032. Health Ministers Meeting.