Prevention vs. Treatment(cont...)

During the last few decades, knowledge of pathophysiology, of risk factors and their role in causing disease, and of the impact of reducing risk factors on developing disease, has increased dramatically. In addition, many effective treatments to lower the risk of complications have been developed. Several studies have examined these secular trends to determine the factors accounting for these declines (see the sources at Table 4.1 for a nonexhaustive listing).

The main finding was that nearly half the reduction can be attributed to population-level changes in risk factors, such as tobacco use, diet, and physical activity, and the rest to treatment of disease and its complications—with most of the treatment effect due to medication use (Table 5.1). This makes a case that both prevention and treatment are needed and that the challenge is determining the strategic mix. For mental health and injury, the situation is

similar and calls for consideration of both prevention and treatment.

Table 4.1 Reduction in secular trend of CVD mortality attributed to population-level risk reduction and to treatment with mediation and surgery (%)

Sources: Bennett et al. 2006; Capewell 1999; Capewell et al. 1999; Capewell, Beaglehole et al. 2000; Capewell, Livingston et al. 2000; Ford et al. 2007; Vartiainen et al. 1994.

The distribution of risk in the population must also be considered. Currently, most people will be of low or moderate risk for developing disease and its complications (possibly 75–80 percent). The remaining 20–25 percent are at high risk and have already had (or soon will) have disease onset. The goal for the former group is to keep them from moving to high risk, or, optimally, to move them toward lower risk for disease onset.

This is primarily accomplished through population-level risk factor reduction supplemented with individual-level health promotion reinforcement during routine clinic encounters. The goal for the latter category is to reduce the risk of developing disease-related complications and disability through individual clinic-based efforts. Additionally, those at high risk will also benefit from population-based measures since they are also community members.