The decline of numerous diseases cannot be attributed exclusively to medical progress. At the same time, investments have been made in prevention in recent years. This takes place at various levels and aims to prevent complaints.
What is prevention?
The general goal of prevention is to improve as well as maintain individual health. Prevention and early detection are closely related. Early detection can be classified as a part of prevention. Both approaches pursue similar goals. Prevention is largely subsidized by the state in order to be able to save costs in this way as well. For example, prevention takes place within the framework of the various statutory insurance schemes. These offer health-promoting services, each of which is anchored in guidelines. In 2012, a total of 10.9 billion euros was invested in disease prevention. However, the measures cannot be generalized. They are differentiated into primary, secondary, tertiary and quaternary prevention and applied in different ways. The patient’s health is to be maintained or improved. This is based on financial reasons, on the one hand, and on ethical reasons, on the other, which aim to avoid suffering as far as possible. An important part of prevention is also health promotion. While prevention looks for factors that cause illness, health promotion strives for those that lead to health. Both approaches are intertwined within their same goal.
Function, effect, and goals
In the case of prevention measures, it is necessary to differentiate between different points in time. These in turn can be classified as primary, secondary, tertiary or quaternary prevention. Thus, primary prevention aims to prevent the development of diseases. Here, measures at the individual level come into play, such as the recommendation and promoted offer for more exercise, programs of the health insurance companies for an education about healthy nutrition or accompanying assistance for the achievement of a normal weight. Numerous diseases are more likely to develop if people are overweight, under stress or have an unhealthy diet. For example, the regular intake of a lot of sugar can result in diabetes, while animal products can possibly lead to heart attacks and strokes due to the cholesterol they contain. Changing one’s diet to include a large proportion of fresh foods such as fruits and vegetables and reducing finished products containing trans fatty acids will counteract complaints. Primary prevention also includes addiction prevention and vaccinations. In some models, primary prevention is followed by primordial prevention to avoid risk factors. Secondary prevention is closely linked to early detection. Thus, it includes all measures to diagnose diseases before they become apparent through symptoms and complaints. It includes patients who become ill as a result of early detection measures, such as radiation exposure during mammography screening. In general, secondary prevention manifests itself in a variety of ways. It includes blood counts, colonoscopies, fecal occult blood testing, ultrasound imaging during pregnancy, or child and adolescent screening. Teritary prevention, on the other hand, is used only after an acute episode of a disease has occurred. It is intended to prevent relapses as well as permanent damage. Thus, the terms tertiary prevention and rehabilitation are similar. They include, for example, the prevention of kidney failure in people who are dependent on external insulin due to diabetes. Furthermore, follow-up examinations after successful cancer treatment can be assigned to the category. Quaternary prevention is aimed primarily at older patients and the chronically ill. It is aimed at avoiding the administration of unnecessary medication. Multimedication can bring more harm than good. To achieve the goals of prevention, measures are applied at different levels. Behavioral prevention aims to influence individual health behavior. Here, for example, strengthening awareness of diseases and prevention, education and sanctions are used. Pointing out health disadvantages, which can be found on cigarette packets, belongs to behavioral prevention.Relational prevention aims to shape living conditions so that they do not pose a health risk. It is anchored in various areas such as family, work or leisure. An example would be a strict no-smoking law, which is reflected in the ban on tobacco consumption in restaurants. Prevention is directed at the individual. They are partly enforced by laws or with the help of incentives and sanctions. Not all measures affect the entire population, so a further differentiation can be made here. Universal prevention is aimed at the population as a whole and sections such as pregnant women, selective prevention at people with a high risk of disease, and indicated prevention at patients who exhibit behavior that can result in disease. These include drug addicts, for example.
Risks and dangers
Prevention thus takes place on numerous levels and has different addressees. Its general goal is the improvement as well as the preservation of the individual health. However, particularly in the context of secondary prevention, disadvantages can also arise. This area is dedicated to early detection. Here, various measures are used which can, under certain circumstances, worsen health. For example, the material used in a colonoscopy can injure the intestinal wall. This results in bleeding or the formation of scars. In addition, mammography screening is criticized by experts. It can indeed contribute to the early diagnosis of breast cancer. However, the radiation is also responsible for the development of tissue changes in previously healthy women. Similar circumstances can be found in all preventive examinations that require the use of ultrasound and X-rays. Otherwise, as a rule, no complaints or side effects are to be expected in the context of prevention. Instead, due to prevention, health benefits are recorded, which are visible in the decrease of numerous diseases. If in doubt, the treating physician should be consulted to weigh the costs and benefits.