Disease prevention
Disease prevention, understood as specific, population-based and individual-based interventions
for primary and secondary (early detection) prevention, aiming to minimize the burden of
diseases and associated risk factors.
Primary prevention refers to actions aimed at avoiding the manifestation of a disease (this may
include actions to improve health through changing the impact of social and economic
determinants on health; the provision of information on behavioral and medical health risks,
alongside consultation and measures to decrease them at the personal and community level;
nutritional and food supplementation; oral and dental hygiene education; and clinical preventive
services such as immunization and vaccination of children, adults and the elderly, as well as
vaccination or post-exposure prophylaxis for people exposed to a communicable disease).
Secondary prevention deals with early detection when this improves the chances for positive
health outcomes (this comprises activities such as evidence-based screening programs for early
detection of diseases or for prevention of congenital malformations; and preventive drug
therapies of proven effectiveness when administered at an early stage of the disease).
It should be noted that while primary prevention activities may be implemented independently of
capacity-building in other health care services, this is not the case for secondary prevention.
Screening and early detection is of limited value (and may even be detrimental to the patient) if
abnormalities cannot be promptly corrected or treated through services from other parts of the
health care system. Moreover, a good system of primary health care with a registered population
facilitates the optimal organization and delivery of accessible population based screening
programs and should be vigorously promoted.
Primary prevention services and activities include:
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 (ex. counselling); and
Nutritional and food supplementation; and
Dental hygiene education and oral health services.
Secondary prevention includes activities such as:
Population-based screening programmes for early detection of diseases;
Provision of maternal and child health programmes, including screening and prevention of
congenital malformations; and
Provision of chemo-prophylactic agents to control risk factors (e.g., hypertension)
Health promotion
Health promotion is the process of empowering people to increase control over their health and
its determinants through health literacy efforts and multisectoral action to increase healthy
behaviors. This process includes activities for the community-at-large or for populations at
increased risk of negative health outcomes. Health promotion usually addresses behavioral risk
factors such as tobacco use, obesity, diet and physical inactivity, as well as the areas of mental
health, injury prevention, drug abuse control, alcohol control, health behavior related to HIV, and
sexual health.
Disease prevention and health promotion share many goals, and there is considerable overlap
between functions. On a conceptual level, it is useful to characterize disease prevention services
as those primarily concentrated within the health care sector, and health promotion services as
those that depend on intersectoral actions and/or are concerned with the social determinants of
health.
Principles of Health Promotion
Empowerment - a way of working to enable people to gain greater control over decisions and
actions affecting their health.
Participative - where people take an active part in decision making.
Holistic - taking account of the separate influences on health and the interaction of these
dimensions.
Equitable - ensuring fairness of outcomes for service users.
Intersectoral - working in partnership with other relevant agencies/organisations.
Sustainable - ensuring that the outcomes of health promotion activities are sustainable in the long
term.
Multi Strategy - working on a number of strategy areas such as programmes, policy.
Scope of the function
Health promotion
Policies and interventions to address tobacco, alcohol, physical activity and diet (e.g., FCTC ,
DPAS , alcohol strategy and NCD best-buys)
Dietary and nutritional intervention should also appropriately tackle malnutrition, defined as a
condition that arises from eating a diet in which certain nutrients are lacking, in excess (too high
in intake), or in the wrong proportions
Intersectoral policies and health services interventions to address mental health and substance
abuse
Strategies to promote sexual and reproductive health, including through health education and
increased access to sexual and reproductive health, and family planning services
Strategies to tackle domestic violence, including public awareness campaigns; treatment and
protection of victims; and linkage with law enforcement and social services.
Support mechanisms for health promotion and disease prevention
Multisectoral partnerships for health promotion and disease prevention
Educational and social communication activities aimed at promoting healthy conditions,
lifestyles, behavior and environments (see EPHO VII)
Reorientation of health services to develop care models that encourage disease prevention and
health promotion
Risk communication.
Barriers to Health Promotion and Disease Prevention in Rural Areas
Rural communities experience a higher prevalence of chronic conditions than their urban
counterparts. Examples of chronic conditions include heart disease, cancer, chronic respiratory
disease, stroke, and diabetes. Rural communities also experience higher rates of mortality and
disability than urban communities. Limited access to health promotion and disease prevention
programs and healthcare services contribute to these health challenges.
Examples of social determinants that are barriers for rural communities in accessing healthcare
include:
Higher poverty rates, which can make it difficult for participants to pay for services or programs
Cultural and social norms surrounding health behaviors
Low health literacy levels and incomplete perceptions of health
Linguistic and educational disparities
Limited affordable, reliable, or public transportation options
Unpredictable work hours or unemployment
Lower population densities for program economies of scale coverage
Availability of resources to support personnel, use of facilities, and effective program operation
Lack of access to healthy foods and physical activity options
These shared barriers provide context for the needs of rural communities and an understanding of
the strategies that will be most effective to address rural barriers to care.
