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MDSC 1001:LEVELS OF PREVENTION

AND
DISABILITY
DR. RAVEED KHAN MBBS,MPH,DM
LECTURER-FAMILY MEDICINE

OBJECTIVES
• Define the various levels of disease prevention
• Describe examples for each level of prevention
• Define Disability
• Identify the leading causes of disability
• Discuss the use of screening tests and explain
the basic factors to be considered when using
these tests.

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DISEASE PREVENTION
• Closely related to Health Promotion.
• Health promotion and disease prevention programmes
focus on keeping people healthy.
• Health promotion is defined by the WHO as:
“The process of empowering people to increase
control over their health and its determinants through
health literacy efforts and multi-sectoral action to
increase healthy behaviours.”
• Disease prevention focuses on prevention strategies to
reduce the risk of developing chronic diseases and
other morbidities.

Natural History of Disease

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LEVELS OF DISEASE PREVENTION

• Defined in terms of 4 levels
-Primordial Prevention
-Primary prevention
-Secondary prevention
-Tertiary prevention

Pre-pathological Phase Pathological Phase

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Primordial prevention
• Prevention of the emergence or development of
risk factors.
• E.g. Many adult health problems like obesity and
hypertension begin in childhood as a result of
poor lifestyle habits e.g. Physical inactivity and
consumption of obesogenic foods.
• Banning the sale of sugary drinks in primary
schools is an example of primordial prevention.

Primary prevention
• Primary prevention refers to actions aimed at
avoiding the manifestation of a disease.
• It can be defined as "action taken prior to the
onset of disease, which removes the
possibility that a disease will ever occur."

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Examples of Primary Prevention

• Vaccination and post-exposure prophylaxis of

children, adults and the elderly.
• Provision of information on behavioural and
medical health risks, and measures to reduce
risks at the individual and population levels.
• Inclusion of disease prevention programmes at
primary and specialized health care levels, such
as access to preventive services (e.g. Counselling)
• Nutritional and food supplementation.
• Dental hygiene education and oral health
services.

Secondary Prevention
• Deals with early detection when this improves
the chances for positive health outcomes.
• It can be defined as "action which halts the
progress of a disease at its incipient stage and
prevents complications.“
• Aims to prevent disability.

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Examples of Secondary Prevention

• Population-based screening programmes for

early detection of diseases.
• Provision of maternal and child health
programmes, including screening and
prevention of congenital malformations.
• Provision of pap smears to detect abnormal
cells which may develop into cancer.

Tertiary Prevention
• Attempts to reduce the damage caused by
symptomatic disease by focusing on mental,
physical, and social rehabilitation.
• Unlike secondary prevention, which aims to
prevent disability, the objective of tertiary
prevention is to maximize the remaining
capabilities and functions of an already
disabled patient.

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Examples of Tertiary Prevention

• Cardiac or stroke rehabilitation programmes.
• Chronic disease management programs. (e.g.
for diabetes, renal failure etc)

DISABILITY
• The International Classification of Functioning,
Disability and Health (ICF) defines disability as an
umbrella term for impairments, activity
limitations and participation restrictions.
• Disability is the interaction between individuals
with a health condition (e.g. cerebral palsy, Down
syndrome and depression) and personal and
environmental factors (e.g. negative attitudes,
inaccessible transportation and public buildings,
and limited social supports).

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DISABILITY
• About 15% of the world's population lives
with some form of disability, of whom 2-4%
experience significant difficulties in
functioning.

How do we measure disability?

It is a measure of the disease burden in populations and is equal to

one year of healthy life lost.

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What are the most common causes of

DALYs globally?

SCREENING
• Screening is the presumptive identification of
unrecognized disease or defects by means of
tests, examinations, or other procedures that
can be applied rapidly.
• It is a form of secondary prevention.

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PROPERTIES OF A GOOD SCREENING

TEST
• Should be sensitive (and ideally also specific),
and have good predictive value.

• Simple and cheap.

• Safe and acceptable.

• Reliable.

Sensitivity
• The property of a test to identify the
proportion of truly ill persons in a population
who are identified as ill by a screening test.
• Also known as the true positive rate or
probability of detection.
• E.g. the percentage of sick people who are
correctly identified as having the condition

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Specificity
• Measures the proportion of negatives that are
correctly identified as such.
• Also called the true negative rate.
• E.g. the percentage of healthy people who
are correctly identified as not having the
condition.

Predictive values
• Positive predictive value is the probability
that subjects with a positive screening test
truly have the disease.
• Negative predictive value is the probability
that subjects with a negative screening test
truly don't have the disease.

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Validity and Reliability of a test

• Validity is the extent to which a test is
measuring what it is intended to measure.
• Reliability is the extent to which a test
produces stable and consistent results.

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REFERENCES
• Rural health information hub.
https://www.ruralhealthinfo.org/community-health/health-
promotion/1/definition
• WHO. Office for the Eastern Mediterranean Region.
http://www.emro.who.int/about-who/public-health-functions/health-
promotion-disease-prevention.html
• Institute for work and health.
https://www.iwh.on.ca/wrmb/primary-secondary-and-tertiary-prevention
• Trinidad & Tobago- Findings from the Global Burden of Disease Study.
https://www.thecommonwealth-healthhub.net/wp-
content/uploads/2016/02/Trinidad_CW_CountryProfile_Final_12_14_15.pdf
• Global, regional, and national disability-adjusted life years (DALYs) for 306
diseases and injuries and healthy life expectancy (HALE) for 188 countries,
1990-2013: quantifying the epidemiological transition. Lancet. 2015 Nov 28;
386(10009): 2145–2191. Published online 2015 Aug 28. doi: 10.1016/S0140-
6736(15)61340-X

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