The Importance of Primary Prevention

The Importance of Primary Prevention
Paige M. Breedon and Austin A. Mardon

Disease prevention is seemingly invisible in-between pandemics; the focus is more often on addressing individuals with existing diseases and helping them lead lives with the greatest quality possible. However, addressing disease only once it has manifested in a patient is problematic to public health. Instead, an integrative attitude towards disease prevention and treatment needs to be considered to reduce the burden of disease.

Firstly, it is important to define key types and approaches to prevention. Specifically, there are three main types of disease prevention known as primary, secondary, and tertiary prevention. First, primary prevention involves preventing a disease from occurring when individuals are healthy; such examples include immunization or massive public service campaigns to educate the general population on avoiding certain risk factors for disease [1]. There is a whole area of healthcare dedicated to primary prevention known as primary care that aims to encourage and promote the maintenance or improvement in wellness, decrease in risk factors for disease, and promotion of healthy lifestyle changes that allow for prevention of physical and mental disease [2].

Next, secondary prevention entails detecting the initial stages of a disease, for instance, through screening programs [1]. Lastly, tertiary prevention aims to improve the quality of life in those who already have the disease, for instance, rehabilitation from a stroke [1]. 

These types of prevention can be applied differently depending on the approach to prevention that is taken, consider both population-based versus high-risk approaches to disease prevention. For example, a population-based approach entails prevention provided to entire populations that include healthy individuals, any prevention applied is thereby required to be low-cost, low-risk, and relatively non-invasive [3]. For instance, a massive anti-smoking campaign can be instituted for a community. In contrast, a high-risk approach focuses on individuals in high-risk categories for a given disease, i.e. individuals with a genetic predisposition to a certain type of cancer [3]. Prevention applied through a high-risk approach can afford to be more expensive, invasive, and risky, but that risk is relative to the patient’s potential reward and is thereby justified [3].

Barriers to Prevention
    A paper by Moreno-Peral et al. (2015) organized barriers to primary prevention and the implementation of health promotion into intrapersonal, interpersonal, institutional, and environmental categories. Specifically, intrapersonal barriers to primary prevention may be based on one’s beliefs, motivation, knowledge, skills, and resources [2]. Interpersonal barriers may include family and friends, primary care professionals, specialists, and available tools. Institutional barriers include system interests and goals, perhaps those that can be financially motivated and clinical practice organizations [2]. Finally, environmental barriers to primary prevention and health promotion include socioeconomic, cultural, and physical/built environments [2]. 

It is also worth noting that the approach to prevention can impact general attitudes and outcomes. Through examining the differences in high-risk versus population-based approaches to prevention, Rose (2001) provides some insight into the challenges associated with prevention. Specifically, population-based approaches are seen as less physician and patient motivated and cause a prevention paradox [3]. For example, physicians may be less motivated to give health advice to individuals who appear to be healthy, and patients are less interested in receiving and taking such advice as they seem to be doing fine [3]. Also, the prevention paradox is where the preventive measure brings many benefits to a population but offers little to each participating individual; for instance, wearing a seatbelt poses little individual benefit to a passenger; however, it has an immense benefit for public health [3].

Aside from the social contexts of physicians attempting to promote primary prevention and healthy living among patients, general practitioners also experience barriers to implementing preventative efforts that are a combination of insecurity about reimbursement and lack of scientific evidence; therefore, these concerns should be considered when identifying ways to promote primary prevention and integrate prevention with treatment [4].

Suggestions for Making Primary Prevention a Priority
When deciding on preventative efforts, barriers to prevention and how preventative efforts can work differently based on intended targets/levels must be considered, i.e. if the preventative effort intends to work on an interpersonal level or an environmental and societal level. To exemplify this, consider an example where the goal is to reduce obesity in a given community, efforts can be made by a physician to maintain patient-centred care and shared decision making, whereas, within the environment, a mass media campaign promoting healthy living can be launched [2]. Although, one of these efforts alone will not be enough to make a substantial change, by approaching prevention from all angles and considering how balancing a high-risk and population-based strategy approach can be achieved, investment can be made into the future of population health that will ultimately avert future costs of disease.

Although prioritizing primary care and prevention does not always happen, it is essential to understand that by taking steps today to prevent disease, substantial benefits can occur in the long-term for public health. In the future, barriers need to be acknowledged and further explored, and actions need to be taken to prioritize prevention of many types and approaches. Hopefully, better integration of specific preventive methods into society and medicine can be achieved. 

REFERENCES
[1] Johnson, D. B., Malone, P. J., & Hightower, A. D. (1997). Barriers to primary prevention efforts in the schools: Are we the biggest obstacle to the transfer of knowledge? Applied &    
Preventive Psychology, 6(2), 81–90. https://doi.org/10.1016/S0962-1849(05)80013-7
[2] Moreno-Peral, P., Conejo-Cerón, S., Fernández, A., Berenguera, A., Martínez-Andrés, M., Pons-Vigués, M., … Rubio-Valera, M. (2015). Primary care patients’ perspectives of barriers and enablers of primary prevention and health promotion-a meta-ethnographic synthesis. PloS One, 10(5), e0125004–e0125004. https://doi.org/10.1371/journal.pone.0125004
[3] Rose, G. (2001). Sick individuals and sick populations. (Public Health Classics). Bulletin of the World Health Organization, 79(10), 990–.