Level of Prevention and Public Health.pptx

Public Health

1. Dr. Samreen Misbah MBBS, MPH, MHPE Assistant Professor Community Medicine Department Army Medical College, NUMS, Rawalpindi.

2. Learning Objectives At the end of this session students will be able to: Describe concept of prevention Describe concept of iceberg of disease phenomena List different levels of prevention Identify levels of application of preventive measures and role of modes of intervention in interruption of usual sequence of disease development Attempt a short quiz

3. Introduction 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 "

4. Prevention; Definition and Concept Actions are aimed at eradicating, eliminating or minimizing the impact of disease and disability If none of these are feasible, retarding the progress of the disease and disability.

5. The Iceberg of Disease Symptomatic disease Diabetes, Cancer, Arthritis, Obesity, Fibromyalgia, Heart diseases, autoimmune diseases What the physician sees What the physician does not see Underlying causes Hormonal imbalances Inflammatory balances Immune imbalances Digestive, absorptive imbalances Toxic chemical exposure Toxic emotions (anger, fear, resentment)

6. Natural History of Disease Progression of disease in an individual over time

7. Natural history of disease Pre pathogenesis The preliminary interaction of the agent host and environment in disease production (before man is involved) Pathogenesis The course of disorder in man from first interaction with agent to the changes in form and function or until recovery, defect, disability or death

8. 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

9. Levels of Prevention The concept of prevention is best defined in the context of levels, traditionally called Primordial prevention Primary prevention S econdary prevention T ertiary prevention

10. Modes of intervention; Definition and Concept Any attempt to intervene or interrupt the usual sequence in development of disease in man may be by: Education Provision of treatment Help or social support

11. Modes of Intervention Five modes of intervention correspond to the natural history of any disease Health promotion Specific protection Early diagnosis and treatment Disability limitation Rehabilitation

12. Levels o f Prevention Primordial prevention Prevention of emergence or development of risk factors in chronic diseases Primary prevention Health promotion Specific protection Secondary prevention Early diagnosis & Treatment Tertiary prevention Disability limitation & Rehabilitation

13. Primordial Prevention Primordial prevention consists of actions to minimize future hazards to health Primordial prevention consists of actions and measures that inhibit the emergence of risk factors (establishment factors) known to increase the risk of disease Risk factors : in the form of environmental, economic, social, and behavioral conditions and cultural patterns of living

14. It is the prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared Many adult health problems (e.g., obesity, hypertension) have their early origins in childhood Time when lifestyles are formed (for example, smoking, eating patterns, physical exercise). Primordial Prevention

15. 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 Primordial Prevention

16. It addresses broad health determinants rather than preventing personal exposure to risk factors, which is the goal of primary prevention Primordial Prevention

17. Health Determinants Almost every characteristic of a society can affect the health of its citizens, so could be considered a health determinant

18. Health Determinants Early childhood development Early nutrition, physical development and fitness, as is emotional development are important Income and social status A person’s social status is defined by a combination of their wealth, education, occupation and lifestyle

19. Health Determinants Education and literacy Social position in childhood influences access to educational opportunities Literacy refers to the patient’s ability to understand health information and to follow guidelines

20. Health Determinants Employment, working conditions, and occupational health The physical environment Environmental influences on health can be positive or negative Cover a wide range of factors, from global (climate change) to national and regional issues (air, and water pollution )

21. Health Determinants Individual and Public Health Services Invention of antibiotics, antisepsis, life-saving surgical procedures, advances in pharmaceuticals Public health interventions (sanitation, communicable disease control measures, etc.) Disease prevention (immunization, tobacco control measures, and screening)- major contributions to saving lives and improving health

22. TB In England And Wales

23. Primary Prevention Primary prevention can be defined as the action taken prior to the onset of disease, which removes the possibility that the disease will ever occur S ignifies intervention in the pre-pathogenesis phase of a disease or health problem Primary prevention may be accomplished by measures of “ Health promotion ” and “ specific protection ”

24. Primary Prevention Aims to prevent the disease from occurring Reduces both the incidence and prevalence of a disease

25. Primary Prevention Concept of "positive health" Concept that encourages achievement and maintenance of " an acceptable level of health that will enable every individual to lead a socially and economically productive life" Measures designed to promote general health and well-being , and quality of life of people or by specific protective measures

26. Primary Prevention Health promotion Health education Environmental modifications Nutritional interventions Life style and behavioral changes Periodic health examination Specific protection Immunization Chemoprophylaxis Use of specific nutrients and supplements Protection against occupational hazards Control against environmental hazards

27. Secondary P revention Secondary prevention is used: after the disease has occurred, but before the person notices that anything is wrong the goal of secondary prevention is to find and treat disease early .

28. Secondary Prevention It is defined as “ action which halts the progress of a disease at its early stage and prevents complications” Begins once a patient comes in contact with health worker or a health facility Specific interventions are early diagnosis(e.g. case finding program, screening test) and treatment .

29. Secondary Prevention It attempts to arrest the disease process, restore health by seeking out unrecognized disease and treating it before irreversible pathological changes take place, and reverse communicability of infectious diseases Protects others in the community from acquiring the infection and thus provide at once secondary prevention for the infected ones and primary prevention for their potential contacts

30. Early Diagnosis and Treatment WHO Expert Committee in 1973 defined early detection of health disorders as “ the detection of disturbances of homoeostatic and compensatory mechanism while biochemical, morphological and functional changes are still reversible” The earlier the disease is diagnosed, and treated the better it is for prognosis of the case and in the prevention of the occurrence of other secondary cases

31. Tertiary Prevention Targets the person who already has symptoms of the disease The goals are: P revent damage and pain from the disease S low down the disease P revent the disease from causing other problems i.e. complications. G ive better care to people with the disease M ake people with the disease healthy again and able to do what they used to do

32. Tertiary Prevention The disease process has advanced beyond its early stages It is defined as “ all the measures available to reduce or limit impairments and disabilities, and to promote the patients’ adjustment to irremediable conditions” Intervention that should be accomplished in the stage of tertiary prevention are disability limitation , and rehabilitation

33. Disability Limitation Disease I mpairment D isability H andicap

34. Disability Limitation 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”

35. 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”

36. Two Approaches to Prevention WHO recommended the approaches for the primary prevention of chronic diseases where the risk factors are established: a. Population (mass) strategy b. High -risk strategy

37. Population (mass) strategy “Population strategy" directed at the whole population irrespective of individual risk levels The population approach is directed towards socio-economic, behavioral and lifestyle changes A small reduction in the average blood pressure or serum cholesterol of a population would produce a large reduction in the incidence of cardiovascular disease

38. High-risk strategy High risk strategy aims to bring preventive care to individuals at special risk R equires detection of individuals at high risk by the optimum use of clinical methods

39. Relative risk of coronary heart disease (CHD) mortality in relation to level of systolic blood pressure

40. Percentages of excess CHD deaths due to hypertension at each blood pressure level

41. At which level of prevention health education operate? Health education can be applied at all levels of disease prevention and can be of great help in maximizing the gains from preventive behavior Primary level: preventive behavior to avoid disease in future Secondary level: visit local health centers Tertiary level: appropriate medications

42. QUIZ Match the following statements. Each option may be selected once, more than once, or not at all Encouraging people to protect themselves from the ultraviolet rays of sun is an example of : {Primary prevention} Options include a) Primordial prevention b) Primary prevention c) Secondary prevention d) Tertiary prevention

43. QUIZ Match the following statements. Each option may be selected once, more than once, or not at all Developing better treatments for melanoma is an example of : { Secondary prevention } Options include a) Primordial prevention b) Primary prevention c) Secondary prevention d) Tertiary prevention

44. QUIZ Match the following statements. Each option may be selected once, more than once, or not at all A doctor checking for suspicious skin growths is an example of {Secondary prevention} Options include a) Primordial prevention b) Primary prevention c) Secondary prevention d) Tertiary prevention

45. QUIZ Match the following statements. Each option may be selected once, more than once, or not at all Visual inspection of cervix with 5% acetic acid {Secondary prevention} Options include a) Primordial prevention b) Primary prevention c) Secondary prevention d) Tertiary prevention

46. QUIZ Match the following statements. Each option may be selected once, more than once, or not at all Outlawing (banning) alcohol in certain countries would represent Discouraging children from adopting sedentary life styles { Primordial prevention} Options include a) Primordial prevention b) Primary prevention c) Secondary prevention d) Tertiary prevention

47. QUIZ Match the following statements. Each option may be selected once, more than once, or not at all A campaign against drinking would be an example of Thorough cleaning of operating rooms to prevent post-operative infection is an example of: {Primary P revention} Options include a) Primordial prevention b) Primary prevention c) Secondary prevention d) Tertiary prevention

48. How prevention can help Watch this video! https :// www.youtube.com/watch?v=rAj38E7vrS8

49. QUIZ What different levels of prevention can be suggested in Corona pandemic?

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