LEVELS OF PREVENTION

AND
MODES OF INTERVENTION
The goal of medicine and Public health are to -

• Promote Health
• Preserve Health

• Restore Health

• Minimize suffering & distress

 Successful prevention depends upon
• Knowledge of causation
• Dynamics of transmission
• Identification of risk factors & risk groups
• Availability of prophylactic / early detection
& treatment measures
• An organisation for applying these measures to
appropriate persons in groups
• Continuous evaluation and development of
procedures applied
Many times removal or elimination of a single known
essential cause may be sufficient to prevent a disease.
 Levels of prevention
1. Primordial prevention
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention

These levels of prevention are in relation to the

Natural History of Disease
PRIMORDIAL PREVENTION

Prevention of the emergence or development of risk

factors in countries or population groups in which they
have not yet appeared

Eg: Obesity/Hypertension/DM – Related to lifestyles

like smoking, eating patterns, physical exercise.
PRIMARY PREVENTION

Action taken prior to the onset of disease signifies

intervention in the pre pathogenesis phase of a disease
or health problem.
Eg: Prevention of chronic diseases such as coronary
heart disease, hypertension and cancer are based on
elimination or modification of risk factors.

Modes of intervention
• Health Promotion
• Specific protection
 Health Promotion:
The well known interventions are -

1. Health education: Most cost effective intervention

targets include the general public, Patients, Priority
groups, health care providers, community leaders and
decision makers

2. Environmental modifications: Provision of safe water,

Installation of Sanitary latrines, control of insects and
rodents improvement of housing etc,.
3. Nutritional Interventions: Nutritional improvement of
vulnerable groups, child feeding programmes food
fortification, Nutrition education.

4. Life style and behavioural changes.

Approach

• Population strategy – Directed at the whole

population irrespective of individual risk levels.

• High risk strategy – Preventive care to individuals

at special risk / high risk
SECONDARY PREVENTION:

Definition: Action which halts the progress of a

disease at its incipient stage and prevents complications.

Largely the domain of clinical medicine.

Health programmes initiated by governments are
usually at the level of secondary prevention

Modes of intervention
• Specific protection
• Early diagnosis and treatment
Specific protection:

a. Immunization
b. Use of specific Nutrients
c. Chemoprophylaxis
d. Protection against occupational hazards
e. Protection against accidents

f. Protection from carcinogens

g. Avoidance of allergens
h. Control of specific hazards in general
environment (air pollution, noise pollution etc.)

i. Control of consumer product, quality & safety of

foods, drugs etc.,
Early Diagnosis and treatment

To arrest the disease process

Treating it before irreversible pathological changes

have taken place

Reverses communicability of infectious diseases.

TERTIARY PREVENTION

All measures available to reduce or limit impairments

and disabilities, minimise suffering caused by existing
departures from good health and to promote the patients
adjustment to irremediable conditions.

Signifies intervention in the late pathogenesis phase.

The major causes of disabling impairments in the
developing countries are communicable diseases,
malnutrition, low quality prenatal care and accidents,
accounts for about 70 percent of disability
Modes of intervention
Disability limitation

Rehabilitation

Disability limitation:
Disease Impairment Disability Handicap
The objective of this intervention is to prevent or halt
the transition of disease process from impairment to
handicap.
 Impairment:

Any loss or abnormality of psychological,

physiological or anatomical structure or function.

Eg: Loss of foot, defective vision, mental retardation

Impairment may be visible or invisible, Temporary or
permanent progressive or regressive, primary or secondary
Disability:
Any restriction or lack of ability to perform an
activity in the manner or within the range considered
normal for a human being.
Unable to carry out certain activities considered normal
for his age, sex etc.
Handicap:

Disadvantage for a given individual resulting

from an impairment or disability, that limits or prevents
the fulfillment pf a role that is normal (depending on
age, sex, etc) for that individual.

Eg: Accident - Disease

Loss of foot - Impairment
Cannot walk - Disability
Unemployed - Handicap
 Rehabilitation :
The combined and co-ordinated use of medical,
social, educational and vocational measures for training
and retraining the individual to the highest possible level
of functional ability.

Enabling the disabled and handicapped to achieve social

integration. Social integration has been defined as the
active participation of disabled and handicapped people in
the main stream of community life.
 Rehabilitation involves disciplines such as -
Physiotherapy, occupational therapy, speech therapy,
audiology, psychology, education, social work,
vocational guidance and placement services.
Medical rehabilitation - Restoration of function
Vocational rehabilitation - Restoration of the capacity
earn a livelihood
Social rehabilitation - Restoration of family and
social relationships
Psychological rehabilitation- Restoration of personal
dignity and confidence
Disability prevention:
It relates to al the levels of prevention

Reducing the occurrence of impairment (Immunization

Against polio-primary prevention)

Disability limitation by appropriate treatment

(secondary prevention)

Preventing the transition of disability into handicap

(tertiary prevention)
THANK YOU