What is prevention and preventive medicine

Oleg Apolikhin

January 23, 2012

People's health depends not only on government policy in the field of health care, but also on each individual person. As the famous Soviet health organizer, People's Commissar of Health of the RSFSR Nikolai Semashko said, a disease is easier to prevent than to treat

.
He also developed an effective approach in which early detection of diseases, improved sanitary and epidemiological control and vaccination minimized the possibility of developing diseases. It was Nikolai Semashko who was the creator of the system for protecting motherhood and infancy, protecting the health of children and adolescents, and a network of research medical institutes. All these measures are prevention
.
It can be primary, secondary and tertiary
. In this column I will talk about the primary one.

Secondary prevention

Secondary prevention is aimed at early detection of diseases
.
In this case, it is possible to carry out the most effective and less expensive treatment
. Secondary prevention is the task of medical workers, but the role of the state and the media here is quite large. Usually diseases are diagnosed when a person comes to the doctor with complaints. Unfortunately, people who do not know the symptoms of diseases treat their ailments as normal age-related changes. In such people, diseases are detected at a stage when treatment becomes lengthy, expensive, and sometimes ineffective.

Memo on comprehensive prevention of dental diseases

What every person who cares about oral health needs to remember:

• regular cleaning at home in the morning and evening;
• using floss and mouthwash throughout the day;
• dental examinations every six months;
• high-quality brush, paste and other accessories;
• professional procedures in the clinic, especially if indicated;
• timely treatment of pathologies;
• proper nutrition and a healthy lifestyle.

Screening method

For secondary prevention, a screening method
.
It is based on informing people about the main symptoms of diseases and the need for their early diagnosis through simple examinations. Essentially, this is active medical examination
.
In Russia, the screening system is developing in various fields of medicine. Thus, since 2000, screening of pregnant women and newborns has been carried out. In oncology, screening is carried out for breast cancer, stomach cancer, lung and colon cancer, and cervical cancer. Urology provides screening for prostate cancer, which applies to men over 45 years of age
.
It includes an examination by a urologist, a PSA blood test and an ultrasound of the prostate gland. It is recommended to undergo such an examination once a year,
even in the absence of complaints.
Prostate cancer detected in the first and second stages is completely curable
.
Another example is erectile dysfunction
. It has been proven that this disease is a harbinger of coronary heart disease, myocardial infarction and strokes. Therefore, a patient who complains of erection problems is necessarily referred by urologists to a cardiologist for screening for diseases of the cardiovascular system.

What is prevention and preventive medicine

Prevention (ancient Greek prophylaktikos - protective) is a set of various measures aimed at preventing any phenomenon and/or eliminating risk factors. Preventative healthcare (preventive medicine or prophylaxis) refers to a set of measures aimed at preventing the development of diseases, as opposed to treating diseases. Just as health encompasses a variety of physical and mental conditions, illness and disability are influenced by environmental factors, genetic predisposition, pathogens, and lifestyle. Health, disease and disability are dynamic processes that develop before individuals even realize they are affected. Disease prevention is based on activities that can be classified as primary, secondary and tertiary prevention measures.

Preventive measures are the most important component of the healthcare system, aimed at creating medical and social activity and motivation for a healthy lifestyle among the population. Issues of disease prevention based on compliance with the rules of personal hygiene and rational dietetics occupied a significant place in the medicine of the ancient world. However, the development of the scientific basis for prevention began only in the 19th century. thanks to the development of general biological sciences, medical science in general and the emergence of its numerous disciplines dealing with specific issues, especially physiology, hygiene and epidemiology; The spread of social ideas in clinical medicine played a major role. Every year, millions of people die from preventable causes. The main causes of death are cardiovascular diseases, chronic respiratory diseases, accidental injuries, diabetes mellitus and some infectious diseases. According to the World Health Organization (WHO), approximately 55 million people died worldwide in 2011; two thirds of them are from non-communicable diseases such as cancer, diabetes, chronic cardiovascular and pulmonary diseases. This figure has increased since 2000, when 60% of deaths were due to these causes. Given the increased prevalence of chronic diseases and mortality from these diseases worldwide, the role of preventive healthcare is especially important.

There are many methods for preventing diseases. Adults and children, even if they feel healthy, should periodically consult a doctor for preventive examinations, screening for a certain range of diseases, identifying risk factors for diseases, to discuss issues of a healthy and balanced lifestyle, for information about immunizations, and to maintain a good relationship with your doctor. The most common screenings are for hypertension (high blood pressure), hyperglycemia (high blood sugar, a risk factor for diabetes), hypercholesterolemia (high blood cholesterol), colon cancer, depression, HIV and other common diseases. sexually transmitted diseases, such as chlamydia, syphilis, gonorrhea. Screening also includes a mammogram (to check for breast cancer), a colorectal cancer test, a Pap test (to check for cervical cancer), and osteoporosis. Genetic testing may also be performed as a screening test to identify mutations that cause genetic disorders or predisposition to certain diseases, such as breast or ovarian cancer. However, these measures are not affordable for every person, and the cost-effectiveness of preventive healthcare is still a topic of debate.

LEVELS OF PREVENTION

Preventive health strategies are based on primary, secondary and tertiary levels of prevention. In the 1940s, Hugh R. Leavell and E. Gurney Clark coined the term primary prevention. They worked at the school of public health at Harvard and Columbia universities, and later they introduced the concepts of secondary and tertiary prevention. Goldston (1987) notes that these levels are better described as “prevention, treatment and rehabilitation”, but despite this, the terms primary, secondary and tertiary prevention are still widely used today.

DESCRIPTION OF LEVELS

Primary prevention

Includes methods aimed at preventing the occurrence of disease by eliminating pathogens or by increasing the body's resistance to disease. Examples include immunization, healthy eating, exercise, and quitting smoking.

Secondary prevention

Includes methods aimed at identifying and eliminating an existing disease before its symptoms appear. For example, treatment of arterial hypertension (a risk factor for many cardiovascular diseases), cancer screening.

Tertiary prevention

Includes methods such as rehabilitation and treatment aimed at reducing the negative impact of symptoms of illness and disability. An example would be surgical procedures that stop the spread or progression of a disease.

Primary prevention

Primary prevention consists of “health promotion” and “specific protection”. Activities aimed at improving health involve lifestyle changes, for example, proper nutrition and daily exercise. This helps prevent diseases and makes you feel better. Disease prevention and general well-being can increase our life expectancy. These interventions do not target specific diseases or conditions, but promote health and well-being at a very general level. On the other hand, to promote health and prevent a number of diseases, specific protection is also important. In the case of sexually transmitted diseases such as syphilis, health promotion measures include avoiding contact with microorganisms, maintaining good personal hygiene, routine examinations with a doctor, general sex education, etc., while specific protective measures involve practicing safe sex (eg use of condoms) and the elimination of sexual promiscuity.

Proper nutrition is the main tool of preventive medicine. If better nutritional options were available to low-income individuals, obesity and chronic disease would be better controlled. A “food desert” is an area with limited access to healthy food due to the lack of supermarkets within a reasonable distance. These are often neighborhoods with low-income residents.

Scientific advances in the field of genetics have contributed significantly to the knowledge of hereditary diseases, thereby facilitating progress in the development of protective measures for individuals who carry a particular gene or have an increased predisposition to a particular disease. Genetic testing has allowed doctors to make accurate diagnoses in a shorter time, select an individual approach to treatment and personalize medicine. Likewise, specific protective measures such as drinking water treatment, wastewater treatment, and the development of personal hygiene practices (eg, regular hand washing) have become central to the discovery of infectious disease agents such as bacteria. These discoveries were instrumental in reducing the incidence of infections that often spread in unsanitary conditions.

Finally, based on “new knowledge” in the field of molecular biology, namely epigenetics, a separate category of health promotion has been put forward, indicating that both physical and affective environmental factors affecting the child in fetal and newborn life can determine his health in adulthood. This is called primary prevention . This also includes providing future parents with relevant, objective information about primary health and providing them with support in the period from conception to the first year of the child’s life. This includes adequate maternity leave, ideally for both parents, with support for post-natal care as well as financial assistance if needed.

Secondary prevention

Secondary prevention is aimed at identifying latent (hidden) diseases and preventing the progression of asymptomatic diseases. Certain diseases can be classified as primary or secondary. This depends on the nature of the disease, although in general, primary prevention aims to prevent exposure to the cause of the disease or injury, while secondary prevention aims to identify and treat the disease at an early stage. Secondary prevention means “early diagnosis and timely treatment”, it is aimed at early detection of the disease, preventing its spread to others, and it also means “limiting disability” by preventing potential future complications of disability from the disease. For example, early diagnosis and Timely treatment of patients with syphilis includes a course of antibacterial therapy to destroy the pathogen, as well as screening and treatment of all children born to mothers with syphilis. Limitation of disability for patients with syphilis includes preventive examinations of the cardiovascular system, analysis of cerebrospinal fluid and examination of the central nervous system of patients to detect any complications of the disease, such as blindness or paralysis.

Tertiary prevention

Finally, tertiary prevention aims to reduce the harm caused by diseases and is based on psychological, physical and social rehabilitation. Unlike secondary prevention, which is aimed at preventing disability, the goal of tertiary prevention is to maximize the remaining capabilities and functional abilities of the patient's body - a disabled person. The goals of tertiary prevention include: preventing the occurrence of pain and damage to organs and systems, limiting the progression and development of complications of diseases, and restoring the health and functionality of patients affected by the disease. For patients with syphilis, rehabilitation includes measures aimed at preventing disability due to the disease, these are corrective measures for the blind and paralyzed, or providing advice on the maximum possible restoration of normal daily activities.

METHODS FOR PREVENTION OF VARIOUS DISEASES

Obesity

Obesity is a major risk factor for a wide range of diseases, including cardiovascular disease, hypertension, some types of cancer and type 2 diabetes. To prevent obesity, it is recommended to adhere to a specially designed set of physical exercises, as well as a balanced diet. A healthy person should aim to acquire 10% of their energy from proteins, 15-20% from fats and more than 50% from complex carbohydrates. Along with this, it is necessary to avoid drinking alcohol, as well as foods high in fat, salt and sugar. People with a predominantly sedentary lifestyle should try to engage in at least half an hour of moderate physical activity per day, and then gradually build up to maximum intensity for at least 20 minutes three times a week.

Cancer

Within a few years, cancer has become a global problem. Most cancer incidence occurs in low- and middle-income countries. This is largely due to exposure to carcinogens resulting from industrialization and globalization. However, primary cancer prevention and limiting exposure to risk factors can reduce incidence by one third. Primary prevention of cancer can also prevent the occurrence of other infectious and non-infectious diseases that share risk factors with cancer.

Lungs' cancer

Lung cancer is the leading cause of cancer mortality in many countries. Tobacco is an environmental carcinogen and a leading cause of lung cancer. Of the 25–40% of all cancer deaths, 90% are lung cancer associated with tobacco smoking. Other carcinogens include asbestos and radioactive materials. Both active and passive smoking can lead to lung cancer and ultimately death. Thus, prevention of tobacco smoking is of paramount importance for the prevention of lung cancer.

Tobacco use can be prevented or stopped through a variety of individual, community and government interventions. A significant portion of the adult smoking population acquires this habit before the age of 20. School-based prevention/education programs and counseling resources can help prevent and stop smoking among teens. Other methods include participation in support group programs, nicotine replacement therapy (NRT), hypnosis and self-motivation. Studies show long-term (>1 year) 20% success rate for hypnosis and 10-20% success rate for group therapy.

Cancer screening programs are an effective source of secondary prevention. Previously, the US Mayo Clinic, Johns Hopkins and Memorial Sloan Kettering Cancer Center conducted annual screening x-rays and sputum cytology and found that lung cancer diagnosed at an early stage is highly treatable, so there is a need for widespread investment in such programs.

Legislation can also have an impact on smoking prevention and cessation. In 1992, Massachusetts voters passed a bill to add an additional 25 cent tax on every pack of cigarettes, despite intense lobbying and the tobacco industry spending $7.3 million against the bill. Tax revenues were used to develop educational programs to combat the bad habit and led to a decrease in tobacco smoking in the state.

Lung cancer and smoking are increasingly spreading around the world, especially in China. China accounts for about one third of global tobacco consumption and production. Anti-smoking policies have been ineffective here because China is home to 350 million regular and 750 million passive smokers and has a death rate of more than 1 million. Recommended smoking control measures include reducing the supply of tobacco, increasing taxes on tobacco products, widespread educational campaigns, reducing tobacco industry advertising, and increasing smoking cessation support resources. In Wuhan, China, a school-based anti-tobacco program for teenagers was introduced in 1998, which led to a reduction in the number of regular smokers, although it did not significantly reduce the number of teenagers who started smoking. This program was effective in secondary rather than primary prevention, but it showed that school-based programs have the potential to reduce tobacco use.

Skin cancer

The most dangerous form of skin cancer is melanoma. Prevention in childhood is especially important because we receive a significant portion of ultraviolet radiation from the sun during childhood and adolescence, which can lead to the development of skin cancer in adulthood. In addition, prevention in childhood helps us develop healthy habits that can help us prevent cancer throughout our lives.

There are several methods of primary prevention of skin cancer, these include: limiting sun exposure between 10 am and 4 pm, when sun exposure is strongest, wearing loose clothing made of organic cotton, wide-brimmed hats, sunglasses, using sunscreens that protect both from ultraviolet rays (both UVA and UVB rays), avoid visiting solariums. Sunscreen should be reapplied after sweating, exposure to water (such as after swimming), or after several hours of sun exposure. Since skin cancer is so easy to prevent, doctors recommend introducing school-based prevention education to protect children from excessive UV exposure.

Cervical cancer

Cytological screening is aimed at identifying abnormal lesions in the cervix, so women can undergo preventative treatment before cancer develops. Given that high-quality screening and follow-up care are shown to reduce the incidence of cervical cancer by 80%, sexually active women are now encouraged to undergo a Pap test every 3-5 years in most developed countries. Finland and Iceland have developed effective institutionalized routine monitoring programs, which have resulted in significant reductions in mortality from cervical cancer while using fewer resources than countries without such programs.

In developing Latin American countries such as Chile, Colombia, Costa Rica, and Cuba, both public and private institutional programs have offered routine cytological screening to women since the 1970s. However, these measures have not led to a significant reduction in cervical cancer incidence and mortality in these countries. This is likely due to low quality or ineffective surveys. However, Puerto Rico, which has implemented an early screening program since 1960, has seen a nearly 50% decline in cervical cancer incidence. And between 1950 and 1990, in Brazil, Peru, India, and several of the most at-risk sub-Saharan African countries that lack institutionalized screening programs, cervical cancer mortality fell nearly fourfold.

Colorectal cancer

Colorectal cancer (also known as bowel cancer, colon cancer, rectal cancer) is the second most common form of cancer among women and the third among men, and the fourth most common cause of death after lung, stomach and liver cancer.

Colorectal cancer is also very preventable; About 80 percent of this type of cancer in its early stages appears as a benign growth, usually called a polyp, and is fairly easy to detect and remove during a colonoscopy. Other screening methods for polyps and cancer include a stool occult blood test. Lifestyle changes that can reduce your risk of colorectal cancer include increasing your intake of whole grains, fruits and vegetables, and reducing your intake of red meat.

In addition to primary, secondary and tertiary prevention, there are also individual and public disease prevention. Individual prevention - includes measures to prevent diseases, preserve and improve health, which are carried out by the person himself, and practically comes down to compliance with the norms of a healthy lifestyle, personal hygiene, hygiene of marriage and family relationships, hygiene of clothing, shoes, rational nutrition and drinking regime, hygienic education of the younger generation, a rational regime of work and rest, active physical education. Public prevention - includes a system of social, economic, legislative, educational, sanitary-technical, sanitary-hygienic, anti-epidemic and therapeutic measures, systematically carried out by state institutions and public organizations with the aim of ensuring the comprehensive development of the physical and spiritual strength of citizens, eliminating factors harmful to the health of the population. Public prevention measures are aimed at ensuring a high level of public health, eradicating the causes of diseases, creating optimal conditions for collective life, including working conditions, rest, material support, living conditions, expanding the range of food products and consumer goods, as well as the development of healthcare, education and culture, physical culture. The effectiveness of public prevention measures largely depends on the conscious attitude of citizens to protecting their health and the health of others, on the active participation of the population in the implementation of preventive measures, on how fully each citizen uses the opportunities provided to him by society to strengthen and maintain health. The practical implementation of public prevention requires legislative measures, constant and significant material costs, as well as joint actions of all parts of the state apparatus, medical institutions, industrial enterprises, construction, transport, agro-industrial complex, etc.

EFFICIENCY

There is no general consensus on whether preventive health interventions are cost-effective. However, they are believed to significantly improve quality of life. There are different opinions about what constitutes a “good investment.” Some argue that preventive health measures should save more money relative to their cost. Others vote for "good value" or significant health benefits, even if these measures do not save money. In addition, preventive health care services are often described as a single entity, although they involve many different activities, each of which may not result in any savings or costs. Better differentiation of these services is necessary both to fully understand their impact on health and to calculate the financial implications.

Cost-effective preventive health interventions include vaccinating children and adults, stopping smoking, taking daily aspirin, and screening for alcoholism, obesity, and vision impairment. While these specific services result in relatively little cost-effectiveness, not every prevention intervention generates more than it costs. A study dating back to 1970 found that preventing heart attacks by treating hypertension with drugs early on doesn't actually save money in the long run. The money saved from preventing heart attacks and strokes is only about a quarter of the cost of drugs. Likewise, the cost of medications or dietary changes to reduce high blood cholesterol levels has been found to exceed the subsequent cost of treating heart disease. Because of these findings, some argue that rather than focusing health care reforms solely on preventive care, higher level health care interventions should be given priority.

Cohen et al. 2008 have published several arguments arguing that the cost of preventive measures is lower than the cost of future treatment. The Diabetes Prevention Study Group in 2012 assessed the cost-benefit (quality-adjusted life year, or QALY) of lifestyle changes compared with metformin. They found that neither method resulted in financial savings, but they were both cost-effective in improving the quality of life of the patients studied.

In addition to analyzing costs, preventative health skeptics have also examined the effectiveness of interventions. They argue that using advanced technology to treat existing diseases is in some cases a more efficient use of resources than trying to prevent the disease. Cohen et al (2008) suggest that it is worth exploring and investing in those preventive measures that would benefit the majority of the population. This would allow for the accumulation and distribution of medical benefits at a reasonable cost.

Tertiary prevention

Tertiary prevention is the fight against complications
of diseases.
It is worth considering that the treatment process is the most ineffective and costly
healthcare system.
Currently in Russia, most socially significant diseases are detected in late stages, when only tertiary prevention is possible. These measures are very expensive, and the disease usually ends in disability or death. A typical example
is the treatment of malignant tumors at the third stage.
Even after all measures have been taken to treat the tumors, they often recur and spread to other organs and tissues. Doctors have to resort to more aggressive measures to influence both the tumor and its metastases. Thus, treatment is delayed, the moral strength of the patient and his relatives is depleted, and the financial costs of the medical institution and the state increase. Early detection of diseases reduces costs by 70-90 percent and prolongs life
.

The dangers of alcohol

Some people believe that occasional small amounts of alcohol will not lead to alcohol dependence. Many people, especially adults, understand that alcohol is basically bad and that it can lead to alcoholism, but they still drink alcohol. Usually these are beer and other low-alcohol drinks, with which you can lift your spirits, chat in pleasant company and simply have a cultural time. But gradually, with the development of addiction, more and more fantastic reasons are found for organizing “cultural” leisure. This is already the first stage of alcoholism. Beer is replaced by stronger drinks, and here the second stage is already developing. It in itself is a rather serious disease, but in addition it can lead to the third stage of alcoholism.

Female alcoholism is not as common as male alcoholism, but its impact and negative effects are more significant. Typically, women are more likely than men to hide their addiction to alcohol. Secret alcoholism gradually develops, which at one point becomes obvious. But at this moment it is practically impossible to treat, since the last stage of alcoholism is reached, the obvious signs of which are personality degradation.

Treatment is complicated by another factor: the patient does not want to admit that he has an addiction. And even if he understands this, he does not want to be treated, considering alcohol to be the only salvation in life. In such a situation, it is very important to surround the patient with the atmosphere in which he will be able to give up alcohol. This is what alcohol addiction prevention is designed for.

Positive example of Cuba

A prime example of the success that can be achieved through a prevention system is the Cuban health care system
.
Cuba was able to put into practice the principles of healthcare of the USSR, which were laid down by Nikolai Semashko: prevention, clinical examination and active detection of diseases in the early stages of development. This system is recognized as the best in the world
in terms of cost and efficiency.
The success of Cuba's health care can be expressed in numbers. According to WHO, the average life expectancy of Cubans is almost 76 years
.
For comparison: in the USA – 75 years, in Russia – 65 years. Cuba's per capita health care spending is $363 per year
, in contrast to the United States, where costs at $6,714 per year are among the highest in the world. In Russia, this figure is $638 per year. Cuba's financial investments are effectively spent on primary prevention and the formation of a healthy lifestyle, and not on the use of tertiary prevention, i.e. high-tech costly treatment methods. The experience of Cuba suggests in which direction it is necessary to develop the prevention system in our country.

Tags:

• Lifespan
• Prevention
• Diagnostics

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