1.

Epidemiological Model of Disease Causation: The

Wheel Model
The wheel model is an epidemiological model that provides a comprehensive
framework for understanding the multifactorial nature of disease causation. It
recognizes that diseases often result from the interaction of multiple factors,
including biological, environmental, behavioral, and socio-cultural determinants.
The wheel model depicts these factors as spokes around a central hub, representing
the disease outcome.

Components of the wheel model include:

a) Host Factors: At the center of the wheel model, host factors encompass the
individual's inherent characteristics, including genetic predisposition, age, sex, and
physiological factors.

b) Agent Factors: The spokes of the wheel model represent various agent
factors that contribute to disease causation. These can be infectious agents, such as
bacteria, viruses, or parasites, or non-infectious agents, such as chemicals, toxins,
or physical agents.

c) Environmental Factors: Another set of spokes represents environmental

factors, including physical, biological, and socio-cultural aspects of the
surroundings. This includes natural elements (e.g., climate, geography), built
environments (e.g., housing, sanitation), and socio-cultural factors (e.g.,
socioeconomic status, education).

d) Time: Time is an integral component of the wheel model as it accounts for the
temporal dimension of disease causation. It considers the duration and timing of
exposure to agents, host susceptibility over time, and the interplay of various
factors during the course of the disease.

e) Interactions and Feedback: The wheel model emphasizes the

interconnections and feedback mechanisms among the different components. For
instance, host factors can modify the effect of an agent, and environmental factors
can influence host susceptibility. Feedback loops exist between the host, agent, and
environment, influencing disease progression and outcomes.
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In this model, the host, with its genetic make-up as its core, is presented as the hub
of the wheel, surrounded with the environment, which is separated into biological,
social and physical components. This separation is artificial since these three parts
of the environment are closely interrelated with one another and with host factors.

The wheel model highlights the importance of a comprehensive approach in

understanding disease causation, acknowledging that multiple factors interact and
contribute to the development of diseases. It underscores the need for multi-
disciplinary collaboration and interventions targeting various components to
effectively prevent and control diseases.

1.Levels of Disease Prevention

Disease prevention encompasses primary, secondary, and tertiary prevention,
which address different stages of disease development.

a) Primary Prevention:
Primary prevention aims to prevent the occurrence of disease by addressing risk
factors before the onset of illness. It’s done by avoiding exposure to hazards that
cause illness or injury, modifying unhealthy or unsafe behaviors that may cause
illness or injury, and increasing resistance to illness or injury when exposed.
Strategies at this level include:

 Health promotion and education

 Immunization against infectious diseases.
 Environmental modifications
 Legislation and policy changes

b) Secondary Prevention:
Secondary prevention aims to detect and treat diseases in their early stages,
reducing the impact and progression of the illness. This involves detecting and
treating disease or injury as soon as possible to stop or slow its progression,

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encouraging personal strategies to prevent further injury or recurrence, and
implementing programs to restore people to their original health and function to
prevent long-term problems. . Strategies at this level include:

 daily, low-dose aspirins and/or diet and exercise programs to prevent further
heart attacks or strokes
 Screening programs
 Early detection
 Regular health check-ups

c) Tertiary Prevention:
Tertiary prevention focuses on managing and reducing the impact of established
diseases, aiming to prevent complications and disabilities. It aims to mitigate the
effects of a permanent illness or injury that has permanent consequences. This is
done by helping people deal with long-term, often complex health problems and
disabilities (e.g. chronic illness, permanent disability) to maximize their
functioning, quality of life and life expectancy. Strategies at this level include:

 Disease management and treatment

 Rehabilitation and support services
 Palliative care and end-of-life care
 Supportive interventions
 Vocational rehabilitation programs to retrain workers for new jobs when
they have recovered as much as possible.

By implementing interventions at each level of disease prevention, public health

efforts can effectively reduce the burden of diseases, improve health outcomes, and
enhance the well-being of individuals and populations.

Many health problems require a combination of primary, secondary and tertiary

interventions to achieve a significant degree of prevention and protection.

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Summary
 Primary prevention includes those measures that prevent the onset of
illness before the disease process begins. Immunization against infectious
disease is a good example.
 Secondary prevention includes those measures that lead to early diagnosis
and prompt treatment of a disease. Breast self-examination is a good
example of secondary prevention.
 Tertiary prevention involves the rehabilitation of people who have already
been affected by a disease, or activities to prevent an established disease
from becoming worse.

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References
 https://med.libretexts.org/
 https://www.iwh.on.ca/
 https://courses.lumenlearning.com/

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