Foundations for Health Promotion

Levels of Prevention
Amer Eltwati Ben Irhuma,*

Abstract:
Prevention averts the development of disease that will manifest in the future. It consists of all measures,
including definitive therapy, that limit disease progression. There are three levels of prevention,
primary, secondary, and tertiary that operates on a continuum but may overlap in practice. Primary
prevention precedes disease or dysfunction. Primary prevention intervention includes health promotion,
such as health education about risk factors for heart disease, and specific protection, such as
immunization against hepatitis B. Its purpose is to decrease the vulnerability of the individual or
population to disease or dysfunction.
Secondary prevention ranges from providing screening activities and treating early stages of disease to
limiting disability by averting or delaying the consequences of advanced disease. Tertiary prevention
occurs when a defect or disability is permanent and irreversible. The process involves minimizing the
effect s of disease and disability by surveillance and maintenance activities aimed at preventing
complications and deterioration. Tertiary prevention focuses on rehabilitation to help people attain and
retain an optimal level of functioning regardless of the disabling condition.
Keywords: health, promotion, protection, prevention, primary, secondary, tertiary.

Introduction:
Prevention, in a narrow sense, means averting to intervene effectively in keeping people
the development of disease that will manifest healthy.
in the future. In a broad sense prevention
consists of all measures, including definitive Primary Prevention:
therapy. Leavell and Clark1 defined three Primary prevention precedes disease or
levels of prevention; primary, secondary, and dysfunction. However, primary prevention is
tertiary. Although the levels of prevention are therapeutic in that it includes health as
related to the natural history of disease, they beneficial to well-being, it uses therapeutic
can be used to prevent disease and provide treatment s and, as a process or behavior
starting points in making effective, positive toward enhancing health, it involves symptom
changes in the health status of their clients. identification when teaching stress-reduction
Within the three levels of prevention, there are techniques. Primary prevention intervention
five steps. These steps include; includes health promotion, such as health
1. Heath promotion (primary prevention). education about risk factors for heart disease,
2. Specific protection (primary prevention). and specific protection, such as immunization
3. Early diagnosis and prompt treatment against hepatitis B. Its purpose is to decrease
(secondary prevention). the vulnerability of the individual or
4. Disability limitation (secondary prevention). population to disease or dysfunction.
5. Restoration and rehabilitation (secondary Interventions at this level encourage
prevention). individuals and groups to become more aware
of the means of improving health and the
Some confusion exists in the interpretation of things they can do at the primary preventive
these concepts; therefore, a consistent health and the optimal health level.2-4
understanding of primary, secondary, and
tertiary prevention is essential. The levels of Health Promotion:
prevention operate on a continuum but may Health promotion is defined as "the science
overlap in practice. The health care worker and art of helping people change their lifestyle
must clearly understand the goals of each level to move toward a state of optimal health".
Health promotion holds the best promise for

*) Professor of Surgery & Dean Faculty of Medicine, University of Sebha, Libya.

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 Foundations for Health Promotion …… Amer Eltwati Ben Irhuma.

lower-cost methods of limiting the constant to motivate action, the availability of data to
increase in health care costs and for measure their progress, and their relevance as
empowering people to be responsible to be broad public health issues”. These include:
responsible for the aspects of their lives that physical activity, overweight and obesity,
enhance well-being (Box 1). Health promotion tobacco use, substance abuse, responsible
and disease prevention objectives include sexual behavior, mental health, injury and
increasing the proportion of people who : are violence, environmental quality, immuniza-
at a healthy weight, consume at least two daily tion, and access to health care.2-5
servings of fruit, consume at least three
servings of vegetables with at least one-third Research clearly shows an increase longevity,
being dark green or deep yellow vegetables, a decrease in early mortality and morbidity,
consume at least six daily servings of grain and an improvement in the quality of life for
products with at least one third being whole individuals who have been involved in health
grains, consume less than 10% of calories from promotion. It must be emphasized that health
saturated fat, consume no more than 30% of promotion requires life-style change. Once a
calories from fat, and consume 22400 mg or life-style change has been adopted, vigilance is
less of sodium daily. Healthy people 2010 is needed to ensure that it is maintained to fit
centered on 10 leading indicators that “reflect developmental and environmental Changes.4-6
the major public health concerns in the United
States and were chosen based on their ability

Box 1. Primary prevention – Health promotion

Heath promotion
Health education
Good standard of nutrition adjusted to development al phases of life
Attention to personality development
Provision of adequate housing, recreation , and agreeable working conditions
Marriage counseling and sex education
Genetic screening
Periodic selective examination

Box2. Primary prevention – Specific Protection

Use of specific immunizations

Attention to personal hygiene
Use of environmental sanitation
Protection from accidents
Use of specific nutrients
Protection from carcinogens
Avoidance of allergens

Specific Protection:
This aspects of primary prevention focuses on environmental health risks.6 Primary
protecting people from disease by providing prevention intervention is considered health
immunizations and reducing exposure to protection, because it emphasizes shielding or
occupational hazards, carcinogens, and other defending the body (or the public) from injury.

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 Foundations for Health Promotion …… Amer Eltwati Ben Irhuma.

Implementing interventions that prevent a diagnosis and treatment of nutritional,

specific health problem may seem easier than behavioral, and other related problems.
promoting well-being among individuals, Delayed recognition of disease results in the
groups, or communities; because the variables need to limit future disability in late secondary
are delineated more clearly in prevention than prevention.7,8
in promotion and the potential influences are
less diverse (Box 2). Tertiary Prevention:
Tertiary prevention occurs when a defect or a
Secondary Prevention: disability is permanent and irreversible. The
Although primary prevention measures have process involves minimizing the effects of the
decreased the hazards of chronic diseases such disease and disability by surveillance and
as cardiovascular disease, conditions that maintenance activities aimed at preventing
preclude a healthy quality of life are still complications and deterioration. Tertiary
prevalent. Secondary prevention ranges from prevention focuses on rehabilitation to help
providing screening activities and treating people attain and retain an optimal level of
early stages of disease to limiting disability by functioning regardless of the disabling
averting or delaying the consequences of condition. The objective of is to return the
advanced disease. affected individual to a useful place in society,
maximize remaining capacities, or both. The
Screening is secondary prevention, because the responsibility here is ensure that people with
principal goal is to identify individuals in an disabilities receive services that enable them to
early, detectable stage of the disease process. live and work according to the resources that
However, screening provides an excellent enable them to live and work according to the
opportunity to offer health teaching as a resources that are still to them. When a person
primary protective measure. Screening has a stroke, rehabilitating this individual to
activities have become an important aspects in the highest level of functioning and teaching
the control of chronic diseases such as heart lifestyle change to prevent future strokes are
disease, stroke, and colorectal cancer. examples of tertiary prevention.9,10
Additionally, screening activities provide early

Box 3. Secondary Prevention Box 4. Tertiary Prevention

Early Diagnosis and prompt treatment: Restoration and Rehabilitation

Case-finding by individual and mass screening Provision of hospital and community

surveys facilities for retraining and education
to maximize use of remaining
Selective examinations to: capacities
Cure and prevent disea se process Education of public and industry to use
rehabilitated persons to fullest
Prevent spread of communicable Disease possible extent
Prevent complications and sequelae Selective placement
Shorten period of disability Work therapy

Disability Limitations Use of sheltered colony

Adequate treatment to arrest disease process and

prevent further complications and sequelae
Provision of facilities to limit disability

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