Preventive medicine
Encyclopedia
Preventive medicine or preventive care refers to measures taken to prevent diseases, (or injuries) rather than curing
them or treating
their symptoms. The term contrasts in method with curative
and palliative
medicine, and in scope with public health
methods (which work at the level of population health rather than individual health).
Simple examples of preventive medicine include hand washing
, breastfeeding
, and immunization
s. Preventive care may include examinations and screening tests tailored to an individual's age, health, and family history. For example, a person with a family history of certain cancers or other diseases would begin screening at an earlier age and/or more frequently than those with no family history. On the other side of preventive medicine, some non-profit organizations, such as the Northern California Cancer Center
, apply epidemiological research towards finding ways to prevent diseases.
, the NIDA
and the European Monitoring Centre for Drugs and Drug Addiction
.
Outside the scope of this three-tier model is environmental prevention. Environmental prevention approaches are typically managed at the regulatory or community level, and focus on interventions to deter drug consumption. Prohibition and bans (e.g. on smoking
, alcohol advertising
) may be viewed as the ultimate environmental restriction. However, in practice environmental preventions programmes embrace various initiatives at the macro and micro level, from government monopolies for alcohol sales, through roadside sobriety or drug tests, worker/pupil/student drug testing, increased policing in sensitive settings (near schools, at rock festivals), and legislative guidelines aimed at precipitating punishments (warnings, penalties, fines).
, pest control
, and public health inspections. Public health inspections can include recreational water
s, swimming pool
s, beach
es, food
preparation and serving, and industrial
hygiene
inspections and surveys.
In the United States
, preventive medicine is a medical specialty, one of the 24 recognized by the American Board of Medical Specialties
(ABMS). It encompasses three areas of specialization:
To become board-certified in one of the preventive medicine areas of specialization, a licensed U.S. physician (M.D.
or D.O.) must successfully complete a preventive medicine medical residency program following a one-year internship. Following that, the physician must complete a year of practice in that special area and pass the preventive medicine board examination. The residency program is at least two years in length and includes completion of a master's degree
in public health
(MPH) or equivalent. The board exam takes a full day: the morning session concentrates on general preventive medicine questions, while the afternoon session concentrates on the one of the three areas of specialization that the applicant has studied.
In addition, there are two subspecialty areas of certification:
These certifications require sitting for an examination following successful completion of an MT or UHB fellowship and prior board certification in one of the 24 ABMS-recognized specialties.
"προφυλάσσω" to guard or prevent beforehand) is any medical or public health
procedure whose purpose is to prevent, rather than treat or cure a disease. In general terms, prophylactic measures are divided between primary prophylaxis (to prevent the development of a disease) and secondary prophylaxis (whereby the disease has already developed and the patient is protected against worsening of this process).
For instance, intrauterine device
s (IUD) are highly effective and highly cost effective contraceptives, however where universal health care is not available the initial cost may be a barrier. IUDs work for several years (3 to 7 or more) and cost less over a year or two's time than most other reversible contraceptive methods. They are also highly cost effective, saving health insurers and the public significant costs in unwanted pregnancies. Making contraceptives available with no up front cost is one way to increase usage, improving health and saving money.
Preventive solutions may be less profitable and therefore less attractive to makers and marketers of pharmaceuticals and medical devices. Birth control pills which are taken every day and may take in a thousand dollars over ten years may generate more profits than an IUD, which despite a huge initial markup only generates a few hundred dollars over the same period.
Leading preventive interventions that reduce deaths in children 0–5 years old worldwide, by percent indicated.
Leading causes of preventable deaths in the United States in the year 2000.
Curative care
Curative care or curative medicine is the kind of health care traditionally oriented towards seeking a cure for an existent disease or medical condition...
them or treating
Palliative care
Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...
their symptoms. The term contrasts in method with curative
Curative care
Curative care or curative medicine is the kind of health care traditionally oriented towards seeking a cure for an existent disease or medical condition...
and palliative
Palliative care
Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...
medicine, and in scope with public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
methods (which work at the level of population health rather than individual health).
Levels
Preventive medicine strategies are typically described as taking place at the primary, secondary, tertiary and quaternary prevention levels. In addition, the term primal prevention has been used to describe all measures taken to ensure fetal well-being and prevent any long-term health consequences from gestational history and/or disease. The rationale for such efforts is the evidence demonstrating the link between fetal well-being, or "primal health", and adult health. Primal prevention strategies typically focus on providing future parents with: education regarding the consequences of epigenetic influences on their child, sufficient leave time for both parents, and financial support if required. This includes parenting in infancy as well.Simple examples of preventive medicine include hand washing
Hand washing
Hand washing for hand hygiene is the act of cleaning the hands with or without the use of water or another liquid, or with the use of soap, for the purpose of removing soil, dirt, and/or microorganisms....
, breastfeeding
Breastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...
, and immunization
Immunization
Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an agent ....
s. Preventive care may include examinations and screening tests tailored to an individual's age, health, and family history. For example, a person with a family history of certain cancers or other diseases would begin screening at an earlier age and/or more frequently than those with no family history. On the other side of preventive medicine, some non-profit organizations, such as the Northern California Cancer Center
Northern California Cancer Center
On February 17, 2010, the Northern California Cancer Center officially changed its name to the Cancer Prevention Institute of California . The new name was chosen to more accurately convey the organization’s focus on cancer prevention and its statewide coverage. - External links :*...
, apply epidemiological research towards finding ways to prevent diseases.
| Prevention levels | Doctor’s side | |||||
| Disease | ||||||
| absent | present | |||||
|---|---|---|---|---|---|---|
| Patient’s side |
|Illness | | absent | Primary prevention illness absent disease absent |
Secondary prevention illness absent disease present |
||
| present | Quaternary prevention Quaternary prevention The quaternary prevention, concept coined by the Belgian general practitioner , are the 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... illness present disease absent |
Tertiary prevention illness present disease present |
||||
| Level | Definition |
|---|---|
| Primary prevention | Methods to avoid occurrence of disease. Most population-based health promotion Health promotion Health promotion has been defined by the World Health Organization's 2005 Bangkok Charter for Health Promotion in a Globalized World as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health"... efforts are of this type. |
| Secondary prevention | Methods to diagnose and treat extant disease in early stages before it causes significant morbidity. |
| Quaternary prevention Quaternary prevention The quaternary prevention, concept coined by the Belgian general practitioner , are the 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... |
Methods to mitigate or avoid results of unnecessary or excessive interventions in the health system. |
| Tertiary prevention | Methods to reduce negative impact of extant disease by restoring function and reducing disease-related complications. |
Universal, selective, and indicated
Gordon (1987) in the area of disease prevention, and later Kumpfer and Baxley in the area of substance use proposed a three-tiered preventive intervention classification system: universal, selective, and indicated prevention. Amongst others, this typology has gained favour and is used by the U.S. Institute of MedicineInstitute of Medicine
The Institute of Medicine is a not-for-profit, non-governmental American organization founded in 1970, under the congressional charter of the National Academy of Sciences...
, the NIDA
Nida
Nida may refer to:* Nida, Lithuania* Nida in Poland* Nida , an ancient roman town in the northwestern suburbs of today's Frankfurt am Main, Germany* Nida, Świętokrzyskie Voivodeship, Poland...
and the European Monitoring Centre for Drugs and Drug Addiction
European Monitoring Centre for Drugs and Drug Addiction
The European Monitoring Centre for Drugs and Drug Addiction is an agency of the European Union. Established in 1993, the EMCDDA is located in Lisbon, Portugal.-Mission and role:...
.
| Tier | Definition |
|---|---|
| Universal prevention | Involves whole population (nation, local community, school, district) and aims to prevent or delay the abuse of alcohol Alcohol abuse Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences. Alcohol abuse eventually progresses to alcoholism, a condition in which an individual becomes dependent on alcoholic beverages in order to avoid... , tobacco, and other drugs Drug abuse Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not considered dependent. The term "drug abuse" does not exclude dependency, but is otherwise used in a similar manner in nonmedical contexts... . All individuals, without screening, are provided with information and skills needed to prevent the problem. |
| Selective prevention | Involves groups whose risk of developing problems of alcohol abuse or dependence is above average. Subgroups may be distinguished by traits such as age, gender, family history, or economic status. For example, drug campaigns in recreational settings. |
| Indicated prevention | Involves a screening process, and aims to identify individuals who exhibit early signs of substance abuse and other problem behaviours. Identifiers may include falling grades among students, known problem consumption or conduct disorder Conduct disorder Conduct disorder is psychological disorder diagnosed in childhood that presents itself through a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated... s, alienation from parents, school, and positive peer groups etc. |
Outside the scope of this three-tier model is environmental prevention. Environmental prevention approaches are typically managed at the regulatory or community level, and focus on interventions to deter drug consumption. Prohibition and bans (e.g. on smoking
Smoking ban
Smoking bans are public policies, including criminal laws and occupational safety and health regulations, which prohibit tobacco smoking in workplaces and/or other public spaces...
, alcohol advertising
Alcohol advertising
Alcohol advertising is the promotion of alcoholic beverages by alcohol producers through a variety of media. Along with tobacco advertising, it is one of the most highly-regulated forms of marketing...
) may be viewed as the ultimate environmental restriction. However, in practice environmental preventions programmes embrace various initiatives at the macro and micro level, from government monopolies for alcohol sales, through roadside sobriety or drug tests, worker/pupil/student drug testing, increased policing in sensitive settings (near schools, at rock festivals), and legislative guidelines aimed at precipitating punishments (warnings, penalties, fines).
Professionals
Professionals involved in the public health aspect of this practice may be involved in entomologyEntomology
Entomology is the scientific study of insects, a branch of arthropodology...
, pest control
Pest control
Pest control refers to the regulation or management of a species defined as a pest, usually because it is perceived to be detrimental to a person's health, the ecology or the economy.-History:...
, and public health inspections. Public health inspections can include recreational water
Water
Water is a chemical substance with the chemical formula H2O. A water molecule contains one oxygen and two hydrogen atoms connected by covalent bonds. Water is a liquid at ambient conditions, but it often co-exists on Earth with its solid state, ice, and gaseous state . Water also exists in a...
s, swimming pool
Swimming pool
A swimming pool, swimming bath, wading pool, or simply a pool, is a container filled with water intended for swimming or water-based recreation. There are many standard sizes; the largest is the Olympic-size swimming pool...
s, beach
Beach
A beach is a geological landform along the shoreline of an ocean, sea, lake or river. It usually consists of loose particles which are often composed of rock, such as sand, gravel, shingle, pebbles or cobblestones...
es, food
Food
Food is any substance consumed to provide nutritional support for the body. It is usually of plant or animal origin, and contains essential nutrients, such as carbohydrates, fats, proteins, vitamins, or minerals...
preparation and serving, and industrial
Industry
Industry refers to the production of an economic good or service within an economy.-Industrial sectors:There are four key industrial economic sectors: the primary sector, largely raw material extraction industries such as mining and farming; the secondary sector, involving refining, construction,...
hygiene
Hygiene
Hygiene refers to the set of practices perceived by a community to be associated with the preservation of health and healthy living. While in modern medical sciences there is a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between...
inspections and surveys.
In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, preventive medicine is a medical specialty, one of the 24 recognized by the American Board of Medical Specialties
American Board of Medical Specialties
The American Board of Medical Specialties is a non-profit physician-led umbrella organization for 24 of the 26 approved medical specialty boards in the United States...
(ABMS). It encompasses three areas of specialization:
- General preventive medicine and public health
- Aerospace medicine
- Occupational medicine
To become board-certified in one of the preventive medicine areas of specialization, a licensed U.S. physician (M.D.
Doctor of Medicine
Doctor of Medicine is a doctoral degree for physicians. The degree is granted by medical schools...
or D.O.) must successfully complete a preventive medicine medical residency program following a one-year internship. Following that, the physician must complete a year of practice in that special area and pass the preventive medicine board examination. The residency program is at least two years in length and includes completion of a master's degree
Master's degree
A master's is an academic degree granted to individuals who have undergone study demonstrating a mastery or high-order overview of a specific field of study or area of professional practice...
in public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
(MPH) or equivalent. The board exam takes a full day: the morning session concentrates on general preventive medicine questions, while the afternoon session concentrates on the one of the three areas of specialization that the applicant has studied.
In addition, there are two subspecialty areas of certification:
- Medical toxicologyMedical toxicologyMedical toxicology, or clinical toxicology, is a subspecialty of medicine. It is practiced by toxicologists, but toxicologic knowledge is often used in emergency medicine, occupational medicine and pediatrics...
(MT) - Undersea and hyperbaric medicine (UHB), formerly "undersea medicine"
These certifications require sitting for an examination following successful completion of an MT or UHB fellowship and prior board certification in one of the 24 ABMS-recognized specialties.
Prophylaxis
Prophylaxis (GreekGreek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...
"προφυλάσσω" to guard or prevent beforehand) is any medical or public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
procedure whose purpose is to prevent, rather than treat or cure a disease. In general terms, prophylactic measures are divided between primary prophylaxis (to prevent the development of a disease) and secondary prophylaxis (whereby the disease has already developed and the patient is protected against worsening of this process).
Examples
Some specific examples of prophylaxis include:- Many vaccineVaccineA vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins...
s are prophylactic, vaccines such as polio vaccinePolio vaccineTwo polio vaccines are used throughout the world to combat poliomyelitis . The first was developed by Jonas Salk and first tested in 1952. Announced to the world by Salk on April 12, 1955, it consists of an injected dose of inactivated poliovirus. An oral vaccine was developed by Albert Sabin...
, smallpox vaccineSmallpox vaccineThe smallpox vaccine was the first successful vaccine to be developed. The process of vaccination was discovered by Edward Jenner in 1796, who acted upon his observation that milkmaids who caught the cowpox virus did not catch smallpox...
, measles vaccineMeasles vaccineMeasles vaccine is a highly effective vaccine used against measles. The measles-mumps-rubella-varicella combo vaccine has been available since 2005...
, mumps vaccineMumps vaccineSeveral varieties of mumps vaccine have been used since 1949, and at least 10 strains were in use in 2006:The first vaccine was a killed mumps virus vaccine developed in 1948 and used in the United States from 1950-1978. This vaccine produced little immune memory, thus had a short duration of...
and others have greatly reduced many childhood diseases; HPV vaccineHPV vaccineThe human papilloma virus vaccine prevents infection with certain species of human papillomavirus associated with the development of cervical cancer, genital warts, and some less common cancers...
s prevent certain cancers; influenza vaccine. - Birth controlBirth controlBirth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...
methods are used to prevent unwanted pregnancy. CondomCondomA condom is a barrier device most commonly used during sexual intercourse to reduce the probability of pregnancy and spreading sexually transmitted diseases . It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner...
s, for instance, are sometimes referred to as "prophylactics" because of their use to prevent pregnancyPregnancyPregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
as well as the transmission of sexually transmitted infections. - Daily and moderate physical exercisePhysical exercisePhysical exercise is any bodily activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons including strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance, as well as for the purpose of...
in various forms can be called prophylactic because it can maintain or improve one's health. Cycling for transportUtility cyclingUtility cycling encompasses any cycling not done primarily for fitness, recreation such as cycle touring, or sport such as cycle racing, but simply as a means of transport...
appears to very significantly improve health by reducing risk of heart diseases, various cancers, muscular- and skeletal diseases, and overall mortality. - Fluoride therapyFluoride therapyFluoride therapy is the delivery of fluoride to the teeth topically or systemically in order to prevent tooth decay which results in cavities. Most commonly, fluoride is applied topically to the teeth using gels, varnishes, toothpaste/dentifrices or mouth rinse. Systemic delivery involves...
and tooth cleaning, either at home or by a professional, are parts of dental prophylaxis or oral prophylaxis.
- AntibioticAntibioticAn antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s are sometimes used prophylactically: For example, during the 2001 anthrax attacks2001 anthrax attacksThe 2001 anthrax attacks in the United States, also known as Amerithrax from its Federal Bureau of Investigation case name, occurred over the course of several weeks beginning on Tuesday, September 18, 2001, one week after the September 11 attacks. Letters containing anthrax spores were mailed to...
scare in the United States, patients believed to be exposed were given ciprofloxacinCiprofloxacinCiprofloxacin is a synthetic chemotherapeutic antibiotic of the fluoroquinolone drug class.It is a second-generation fluoroquinolone antibacterial. It kills bacteria by interfering with the enzymes that cause DNA to rewind after being copied, which stops synthesis of DNA and of...
. In similar manner, the use of antibiotic ointments on burns and other wounds is prophylactic. Antibiotics are also given prophylactically just before some medical procedures such as pacemaker insertion. - Tricyclic antidepressants (TCAs) may, with caution, be an example of a chronicChronic (medicine)A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...
migraine preventive (see amitriptylineAmitriptylineAmitriptyline is a tricyclic antidepressant . It is the most widely used TCA and has at least equal efficacy against depression as the newer class of SSRIs...
and migraines' prevention by medicine). - AntimalarialsAntimalarial drugAntimalarial medications, also known as antimalarials, are designed to prevent or cure malaria. Such drugs may be used for some or all of the following:* Treatment of malaria in individuals with suspected or confirmed infection...
such as chloroquineChloroquineChloroquine is a 4-aminoquinoline drug used in the treatment or prevention of malaria.-History:Chloroquine , N'--N,N-diethyl-pentane-1,4-diamine, was discovered in 1934 by Hans Andersag and co-workers at the Bayer laboratories who named it "Resochin". It was ignored for a decade because it was...
and mefloquineMefloquineMefloquine hydrochloride is an orally administered medication used in the prevention and treatment of malaria. Mefloquine was developed in the 1970s at the United States Department of Defense's Walter Reed Army Institute of Research as a synthetic analogue of quinine...
are used both in treatment and as prophylaxis by visitors to countries where malariaMalariaMalaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
is endemic to prevent the development of the parasitic PlasmodiumPlasmodiumPlasmodium is a genus of parasitic protists. Infection by these organisms is known as malaria. The genus Plasmodium was described in 1885 by Ettore Marchiafava and Angelo Celli. Currently over 200 species of this genus are recognized and new species continue to be described.Of the over 200 known...
, which cause malariaMalariaMalaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
. - Low-molecular-weight heparin is used as a prophylaxis in hospitalHospitalA hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
patients, as they are at risk for several forms of thrombosisThrombosisThrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss...
due to their immobilisation. - Risk reducing or prophylactic mastectomies may be carried out for carriers of the BRCA mutationBRCA mutationA BRCA mutation is a mutation in either of the genes BRCA1 and BRCA2. Harmful mutations in these genes produce a hereditary breast-ovarian cancer syndrome in affected families...
gene to minimise the risk of developing breast cancerBreast cancerBreast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
. - Early and exclusive breastfeedingBreastfeedingBreastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...
provides immunological protection against infectious diseases and well as reduced risk of chronic diseases for both mother and child. - PolypillPolypillA polypill is a medication that is a combination drug of multiple active ingredients, and that is aimed to be consumed widespread in the population, even currently healthy ones, as a means of preventive medicine...
for prevention of e.g. cardiovascular diseaseCardiovascular diseaseHeart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...
. - Potassium iodidePotassium iodidePotassium iodide is an inorganic compound with the chemical formula KI. This white salt is the most commercially significant iodide compound, with approximately 37,000 tons produced in 1985. It is less hygroscopic than sodium iodide, making it easier to work with...
is used prophylactically to protect the thyroid gland from absorbing inhaled or ingested radioactive iodine, which may lead to the development of thyroid cancerThyroid cancerThyroid neoplasm is a neoplasm or tumor of the thyroid. It can be a benign tumor such as thyroid adenoma, or it can be a malignant neoplasm , such as papillary, follicular, medullary or anaplastic thyroid cancer. Most patients are 25 to 65 years of age when first diagnosed; women are more affected...
; radioactive iodine may be released into the environment in the event of an accident at a nuclear power plant, or the detonation of a nuclear explosive (see thyroid protection due to nuclear accidents and emergencies). - Prophylaxis may be administered as oral medication. Oral prophylaxis includes: PEP, nPEP, or PrEP. PEP stands for post-exposure prophylaxis used in an occupational setting e.g., to prevent the spread of HIV or Hepatitis C from patient to staff following an accidental needlestick. nPEP is non-occupational post-exposure prophylaxis. nPEP may be used in a sexual or injection exposure to HIV, hepatitis, or other infectious agents; for example, during intercourse, if the condom breaks and one partner is HIV-positive, nPEP will help to decrease the probability that the HIV-negative partner becomes infected with HIV. (An nPEP is sometimes known as a PEPse - i.e. post-exposure prophylaxis sexual encounter.) PrEP is a measure taken daily (before, during, and after) possible exposure; for example, by a person who inconsistently uses condoms during sex with a partner who may have an HIV infection.
Limitations
Since preventive medicine deals with healthy individuals or populations the costs and potential harms from interventions need even more careful examination than in treatment. For an intervention to be applied widely it generally needs to be affordable and highly cost effective.For instance, intrauterine device
Intrauterine device
A copper IUD is a type of intrauterine device. Most IUDs have a plastic T- or U-shaped frame which is wrapped in copper wire, with the exception of Gynefix, which is a plastic string with several copper beads, affixed to the fundus of the uterus...
s (IUD) are highly effective and highly cost effective contraceptives, however where universal health care is not available the initial cost may be a barrier. IUDs work for several years (3 to 7 or more) and cost less over a year or two's time than most other reversible contraceptive methods. They are also highly cost effective, saving health insurers and the public significant costs in unwanted pregnancies. Making contraceptives available with no up front cost is one way to increase usage, improving health and saving money.
Preventive solutions may be less profitable and therefore less attractive to makers and marketers of pharmaceuticals and medical devices. Birth control pills which are taken every day and may take in a thousand dollars over ten years may generate more profits than an IUD, which despite a huge initial markup only generates a few hundred dollars over the same period.
Leading cause of preventable death
Leading causes of preventable death worldwide as of the year 2001.| Cause | Deaths caused (millions per year) |
|---|---|
| Hypertension Hypertension Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and... |
7.8 |
| Smoking | 5.0 |
| High cholesterol Hypercholesterolemia Hypercholesterolemia is the presence of high levels of cholesterol in the blood. It is not a disease but a metabolic derangement that can be caused by many diseases, notably cardiovascular disease... |
3.9 |
| Malnutrition Malnutrition Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions.... |
3.8 |
| Sexually transmitted infections | 3.0 |
| Poor diet Diet (nutrition) In nutrition, diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. With the word diet, it is often implied the use of specific intake of nutrition for health or weight-management... |
2.8 |
| Overweight Overweight Overweight is generally defined as having more body fat than is optimally healthy. Being overweight is a common condition, especially where food supplies are plentiful and lifestyles are sedentary... and obesity Obesity Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems... |
2.5 |
| Physical inactivity Sedentary lifestyle Sedentary lifestyle is a medical term used to denote a type of lifestyle with no or irregular physical activity. A person who lives a sedentary lifestyle may colloquially be known as a couch potato. It is commonly found in both the developed and developing world... |
2.0 |
| Alcohol Long-term effects of alcohol The long term effects of alcohol range from possible health benefits for low levels of alcohol consumption to severe detrimental effects in cases of chronic alcohol abuse... |
1.9 |
| Indoor air pollution from solid fuels | 1.8 |
| Unsafe water Waterborne diseases Waterborne diseases are caused by pathogenic microorganisms which are directly transmitted when contaminated fresh water is consumed. Contaminated fresh water, used in the preparation of food, can be the source of foodborne disease through consumption of the same microorganisms... and poor sanitation Sanitation Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems are human and animal feces, solid wastes, domestic... |
1.6 |
Leading preventive interventions that reduce deaths in children 0–5 years old worldwide, by percent indicated.
| Intervention | Percent of all child deaths preventable |
|---|---|
| Breastfeeding Breastfeeding Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or... |
13 |
| Insecticide-treated materials | 7 |
| Complementary feeding | 6 |
| Zinc Zinc Zinc , or spelter , is a metallic chemical element; it has the symbol Zn and atomic number 30. It is the first element in group 12 of the periodic table. Zinc is, in some respects, chemically similar to magnesium, because its ion is of similar size and its only common oxidation state is +2... |
4 |
| Clean delivery | 4 |
| Hib vaccine Hib vaccine Haemophilus influenzae type B vaccine is a conjugate vaccine developed for the prevention of invasive disease caused by Haemophilus influenzae type b bacteria. The Centers for Disease Control and Prevention has recommended the use of the Hib vaccine. Due to routine use of the Hib vaccine in... |
4 |
| Water, sanitation, hygiene | 3 |
| Antenatal steroids | 3 |
| Newborn temperature management | 2 |
| Vitamin A Vitamin A Vitamin A is a vitamin that is needed by the retina of the eye in the form of a specific metabolite, the light-absorbing molecule retinal, that is necessary for both low-light and color vision... |
2 |
| Tetanus toxoid | 2 |
| Nevirapine and replacement feeding | 2 |
| Antibiotics for premature rupture of membranes | 1 |
| Measles vaccine Measles vaccine Measles vaccine is a highly effective vaccine used against measles. The measles-mumps-rubella-varicella combo vaccine has been available since 2005... |
1 |
| Antimalarial intermittent preventive treatment in pregnancy | <1% |
Leading causes of preventable deaths in the United States in the year 2000.
| Cause | Deaths caused | % of all deaths |
|---|---|---|
| Tobacco smoking | 435,000 | 18.1 |
| Poor diet and physical inactivity | 365,000 | 15.2 |
| Alcohol consumption Long-term effects of alcohol The long term effects of alcohol range from possible health benefits for low levels of alcohol consumption to severe detrimental effects in cases of chronic alcohol abuse... |
85,000 | 3.5 |
| Infectious disease Infectious disease Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism... s |
75,000 | 3.1 |
| Toxicant Toxicant A toxicant is a chemical compound that has an effect on organisms.A distinction can be drawn between "toxic" and toxin, with the latter being a subcategory of the former.... s |
55,000 | 2.3 |
| Traffic collisions | 43,000 | 1.8 |
| Firearm incidents Gun violence in the United States Gun violence in the United States is an intensely debated political issue in the United States. Gun-related violence is most common in poor urban areas and in conjunction with gang violence, often involving juveniles or young adults... |
29,000 | 1.2 |
| Sexually transmitted infections | 20,000 | 0.8 |
| Drug abuse Drug abuse Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not considered dependent. The term "drug abuse" does not exclude dependency, but is otherwise used in a similar manner in nonmedical contexts... |
17,000 | 0.7 |
See also
- Post-exposure prophylaxisPost-exposure prophylaxisPost-exposure prophylaxis is any prophylactic treatment started immediately after exposure to a pathogen , in order to prevent infection by the pathogen and the development of disease.-Rabies:...
- Pre-exposure prophylaxisPre-exposure prophylaxisPre-exposure prophylaxis is any medical or public health procedure used before exposure to the disease causing agent, its purpose is to prevent, rather than treat or cure a disease. An example would be if a doctor gave a medication used to treat a disease to a healthy person who is not thought to...
- Prophylactic ruleProphylactic ruleA prophylactic rule is a judicially-crafted rule that overprotects a constitutional right, and gives more protection than such right might abstractly seem to require on its face, in order to safeguard that constitutional right or improve detection of violations of that right. An example is the...
- Quaternary preventionQuaternary preventionThe quaternary prevention, concept coined by the Belgian general practitioner , are the 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...
- Monitoring (medicine)Monitoring (medicine)In medicine, monitoring is the evaluation of a disease or condition over time.It can be performed by continuously measuring certain parameters , and/or by repeatedly performing medical tests .Transmitting data from a monitor to a distant...
- American Journal of Preventive MedicineAmerican Journal of Preventive MedicineAmerican Journal of Preventive MedicineThe American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy...
- Preventive Medicine (journal)Preventive Medicine (journal)Preventive Medicine : An International Journal Devoted to Practice and Theory, is a peer-reviewed academic journal published by Elsevier since 1972.-Coverage:...
Notations
- Sackett DL. The arrogance of preventive medicine. CMAJ. 2004;167:363-4.
- Gérvas J, Pérez Fernández M. Los límites de la prevención clínica. AMF. 2007; 3(6):352-60.
- Gérvas J, Pérez Fernández M, González de Dios J. Problemas prácticos y éticos de la prevención secundaria. A propósito de dos ejemplos de pediatría. Rev Esp Salud Pública. 2007;81:345-52.
- Starfield B, Hyde J, Gérvas J, Heath I. The concept of prevention: a good idea gone astray? J Epidemiol Community Health. 2008;62(7):580-3.
- Gérvas J, Starfield B, Heath I. Is clinical prevention better than cure? Lancet. 2008;372:1997-9.
- Gérvas J, Pérez Fernández M. Los daños provocados por la prevención y por las actividades preventivas. RISAI. 2009; 1(4).
- Gérvas J. Abuso de la prevención clínica. El cribaje del cáncer de mama como ejemplo. Rev Espaço Saùde. 2009; 11(1):49-53.
- Gérvas J, Heath I, Durán A, Gené J; Members of the Seminar of Primary Health Innovation 2008. Clinical prevention: patients' fear and the doctor's guilt. Eur J Gen Pract. 2009; 15(3):122-4.
- Heneghan C. Considerable uncertainty remains in the evidence for primary prevention of cardiovascular disease (editorial). The Cochrane Library 2011 (19 Jan).
External links
- US Preventive Medicine Task Force
- US Preventive Medicine
- The Prevention Plan
- Health-EU Portal Prevention and Promotion