Preventive medicine or preventive care refers to measures taken to prevent diseases,[1] (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).
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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.[2] The rationale for such efforts is the evidence demonstrating the link between fetal well-being, or "primal health," and adult health.[3][4] Primal prevention strategies typically focus on providing future parents with: education regarding the consequences of epigenetic influences on their child,[5] 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, breastfeeding, and immunizations. 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 such family history. On the other side of preventive medicine, some nonprofit organizations, such as the Northern California Cancer Center, apply epidemiologic research towards finding ways to prevent diseases.
| Prevention levels[6] | 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 illness present disease absent |
Tertiary prevention illness present disease present |
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| Level | Definition |
|---|---|
| Primary prevention | Methods to avoid occurrence of disease.[7] Most population-based health promotion efforts are of this type. |
| Secondary prevention | Methods to diagnose and treat extant disease in early stages before it causes significant morbidity.[8] |
| Tertiary prevention | Methods to reduce negative impact of extant disease by restoring function and reducing disease-related complications.[9] |
| Quaternary prevention | Methods to mitigate or avoid results of unnecessary or excessive interventions in the health system.[10] |
Gordon (1987) in the area of disease prevention,[11] and later Kumpfer and Baxley in the area of substance use[12] 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 Medicine, the NIDA and the European Monitoring Centre for Drugs and Drug Addiction.
| Tier | Definition |
|---|---|
| Universal prevention | Involves whole population (nation, local community, school, district) and aims to prevent or delay the abuse of alcohol, tobacco, and other drugs. 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 disorders, 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 ways 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 programs 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 involved in the public health aspect of this practice may be involved in entomology, pest control, and public health inspections. Public health inspections can include recreational waters, swimming pools, beaches, 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.
Prophylaxis (Greek "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).
Some specific examples of prophylaxis include:
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 devices (IUD) are highly effective and highly cost effective contraceptives, however where universal health care is not available the initial cost may be a barrier.[17] 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.[18] They are also highly cost effective, saving health insurers and the public significant costs in unwanted pregnancies.[18] Making contraceptives available with no up front cost is one way to increase usage, improving health and saving money.[19]
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.[17]
Leading causes of preventable death worldwide as of the year 2001.[20]
| Cause | Deaths caused (millions per year) |
|---|---|
| Hypertension | 7.8 |
| Smoking | 5.0 |
| High cholesterol | 3.9 |
| Malnutrition | 3.8 |
| Sexually transmitted infections | 3.0 |
| Poor diet | 2.8 |
| Overweight and obesity | 2.5 |
| Physical inactivity | 2.0 |
| Alcohol | 1.9 |
| Indoor air pollution from solid fuels | 1.8 |
| Unsafe water and poor sanitation | 1.6 |
Leading preventive interventions that reduce deaths in children 0–5 years old worldwide, by percent indicated.[21]
| Intervention | Percent of all child deaths preventable |
|---|---|
| Breastfeeding | 13 |
| Insecticide-treated materials | 7 |
| Complementary feeding | 6 |
| Zinc | 4 |
| Clean delivery | 4 |
| Hib vaccine | 4 |
| Water, sanitation, hygiene | 3 |
| Antenatal steroids | 3 |
| Newborn temperature management | 2 |
| Vitamin A | 2 |
| Tetanus toxoid | 2 |
| Nevirapine and replacement feeding | 2 |
| Antibiotics for premature rupture of membranes | 1 |
| Measles vaccine | 1 |
| Antimalarial intermittent preventive treatment in pregnancy | <1% |
Leading causes of preventable deaths in the United States in the year 2000.[22]
| Cause | Deaths caused | % of all deaths |
|---|---|---|
| Tobacco smoking | 435,000 | 18.1 |
| Poor diet and physical inactivity | 365,000 | 15.2 |
| Alcohol consumption | 85,000 | 3.5 |
| Infectious diseases | 75,000 | 3.1 |
| Toxicants | 55,000 | 2.3 |
| Traffic collisions | 43,000 | 1.8 |
| Firearm incidents | 29,000 | 1.2 |
| Sexually transmitted infections | 20,000 | 0.8 |
| Drug abuse | 17,000 | 0.7 |
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