Prevention refers to any measure aimed at reducing risks or the harmful consequences of disasters, or to weaken other undesirable situations. Preventive healthcare deals with the prevention of illness and can be applied at all stages across the lifespan and along a disease spectrum, to prevent further decline over time. Early detection will limit the need for medical treatment.
There are three distinct levels of prevention. Measures that prevent the onset of illness or injury belong to primary prevention. Vaccinations and regular exercise are examples. At the primary level there is a huge prevention potential in individual lifestyles through altering risky behaviour, for example: smoking, alcohol abuse, malnutrition or insufficient physical activity.
To detect diseases in their early stages before the illness progresses is the concept of secondary prevention. Early diagnosis and prompt treatment to prevent more severe problems are part of it. Good examples are screening for high blood pressure (nearly half of the adults in many countries have this) or the self-examination of certain diseases, for example breast cancer. Thus early treatment for the health problems of the population is important.
Tertiary prevention refers to measures following illness, such as rehabilitation or reduction of established diseases. Professional help may work to retrain or re-educate people with impairments. At this level, education of people to take their medication appropriately is important, at the time of rehabilitation of the individual patient who had already a disability.
Preventive medicine and public health share the same objectives: promoting population health, preventing disease and improving the health environment on the basis of epidemiological data in cooperation with centers for disease control and prevention.
Preventive care includes doctor visits, well-child visits, dental cleanings, immunizations, contraception, etc. The underuse of many of these preventive services do not stem from a gap in information, according to experts, but more from implementation and a lack of health education.
A frequently asked question is: does preventive care save money? It is difficult to say; selected empirical studies show mixed results. They depend on the cost-effectiveness of selected preventive measures and treatments for existing conditions. Such a comparison between guided self-management and traditional care for asthma, for example, done on the basis of 599 studies showed that less than 20% of preventive options fall in the cost-saving category, whilst 80% add more to medical costs than they save.1
The prevention potential within chronic diseases is particularly positive in the long run. The individual lifestyle of the population may improve the health status a lot. On the basis of this assumption, there is a clear cost decrease over a time span of 20 years.2
An overall answer is so difficult because of the separation between primary prevention, on the one hand, and secondary and tertiary prevention, on the other hand. As primary prevention includes less medical treatment than the other two forms of prevention, the calculations done on the basis of the cost-of-illness studies show results ranging from higher expenditures through prevention programs to lower costs of other programs. The avoidance of indirect costs is so far less important than the containment of direct costs (expenditures). Thus we are saving at the wrong end!
Health impact assessment (HIA) might be a better approach or at least an alternative. It is a type of study that helps policy-makers identify the likely health impacts of a decision in other fields. HIAs can help decision makers to avoid unintended health risks, reduce unnecessary costs, find practical solutions and leverage opportunities to improve the well-being of the community in which the project or policy is proposed. Some experts call it macro allocation.
Finally a prevention-oriented society may try to find additional healthy life years on the basis of three key hypotheses:
- a healthier society saves money on medical treatment through primary prevention;
- healthy aging gives a demand-side boost by increasing private demand for non-reimbursable health related goods and services (second health market);
- furthermore, a better health status raises productivity and thus gives a supply-side boost to quality of life and economic growth.
1 Louise Russell, Preventing Chronic diseases: an Import Investment. But don't count on cost savings Health affairs, 2012.
2 Karl Martin and Kaus-Dirk Henke, Gesundheitsökonomische Szenarien zur Prävention, Baden-Baden 2008, page 72-73.
3 Michael E. Porter, Elizabeth Olmsted Teisberg. Redefining Health Care – Creating value-based competition on results. Harvard Business School Press, 2006, Appendix B.
4 Cohen, J.T. et al. Does preventive care save money? New England Journal of Medicine, 14 February 2008, pp 661-663.
5 Factors determining the knowledge and prevention practice of healthcare workers towards COVID-19 in Amhara region, Ethiopia: a cross-sectional survey, August 2020.
6 Klaus-Dirk Henke. June 2015. Health economic benefits. German National Academy of Science, Health education and prevention, Rapporteur´s report of the workshop. Supplement p. 11-17.