Prevention of NCDs

Prevention of NCDs

The commonly used construct for combating NCDs—primary, secondary, and tertiary prevention (Box 4.2)—is useful, especially for health workers considering the range of interventions within populations for which they provide care. It also conforms to the different levels of health services, which are relevant to health care providers and policy makers.

Box 4.2 Construct for NCDs

Primary prevention is directed toward entire populations or subgroups at high risk. The interventions fall into three broad categories: personal behavior change, control of environmental hazards, and population-based medical interventions such as immunization. The aim of primary prevention is to reduce the level of one of more identified risk factors that will result in lowering the probability of the initial occurrence of a disease.

Smoking cessation in the population due to a higher tax for cigarettes is an example.

Secondary prevention consists of ongoing interventions (chronic care) aimed at decreasing the

severity and frequency of recurrent events or complications of chronic diseases. Treating blood

pressure to prevent heart attacks or blood glucose to prevent ketoacidosis and development of

diabetic retinopathy are examples.

Tertiary prevention generally consists of the prevention of disease progression and attendant suffering after the disease is clinically obvious and a diagnosis established. This activity also includes the rehabilitation of disabling conditions. Examples include preventing recurrence of heart attack with anticlotting medications and physical modalities to regain function among stroke patients.

For many common chronic illnesses, protocols to promote secondary and tertiary preventive interventions have been developed, often called “disease management.” Disease treatments are not usually included, but the boundary with tertiary prevention is not always clear.

Various operational definitions are used for primary, secondary, and tertiary level prevention. Also, depending on the condition or disease, treatment can be consider primary prevention for one condition but secondary prevention for another condition—making the terminology less useful. Thus this book focuses on where policies will be implemented (such as outside or inside the sector, or the clinic).