Disease prevention activities focus on the major health problems that are known to be amenable to preventative intervention. In public health, it has been common practice to categorise the different goals – or levels – of prevention across a ‘stages of disease’ continuum in terms of primary, secondary and tertiary prevention. Many of these relate to approaches that can be delivered by the health sector. In addition, in some countries, public health applies strategic and planning skills to improve health service management.
Components of public health prevention include:
Primary prevention: aims to promote population health and well-being and prevent disease and harm before it occurs. It is seen as an ‘upstream approach’ and links to health promotion activities, including the environmental determinants of health.
- Vaccinations are a key primary prevention function.
- WHO-recommended immunisations include:
- Childhood: Bacillus Calmette–Guerin(BCG), hepatitis B, polio, diphtheria–tetanus–pertussis (DTP), Haemophilus Influenzae type B (Hib), pneumoccocus, rotavirus, measles, rubella, human papilloma virus (HPV).
- Adult: travel vaccinations.
- Older people: influenza, pneumococcus.
Secondary prevention: aims to prevent the progression of disease through early detection and intervention, for example:
- Child development and maternal health: for example, breast feeding, nutrition and weight, complementary feeding, food supplements (e.g. vitamin A, iron and folic acid), blood pressure, smoking, infections, developmental milestones, mental health and abuse.
- Screening and management for communicable and non-communicable diseases, for example cervical screening; high blood pressure; tobacco; alcohol; body mass index; sexually transmitted diseases; blood-borne infections; high prevalence of infections in certain risk groups.
Tertiary prevention: rehabilitation, healthcare management and planning:
- Applying public health leadership and management using assessment, cost effectiveness, prioritisation and planning to improve the quality, safety, effectiveness and efficiency of health service delivery.
- Re-orientating health services to play a larger role in primary and secondary prevention, through the delivery of people centred, integrated primary healthcare services, to lower costs and improve the overall sustainability of health outcomes.
- Promoting healthy settings through health promoting hospitals and healthcare to provide a systems approach to improving the health of patients as well as staff.