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Our mission at Appt is to ensure that everyone can live a healthy, independent life free from ill-health. One way we do that is through the technology we are building which supports health care providers to boost the uptake of preventative care programmes. And another way is to build a community that champions prevention and spreads awareness of preventive healthcare's benefits.
When talking to people, even health care providers like nurse practitioners, HCAs, and GPs, we often find a lack of understanding about the term "preventative care". But once we give examples everyone knows exactly what we are talking about. And, they often find it's part of their job although known under a different name (like immunisation, screenings, and medicines use reviews). People straight away know their work in these areas save lives and want to learn more about extending that work.
Using the FAQs we receive directly in these conversations we discovered that the best place to start is with these two questions:
1) What is preventative health care?
2) Why is public health so important?
In other words, the best place to start is a concrete definition of prevention within a wider context of its value. To do this we will tackle each of these questions for you, one by one.
After some research, we quickly realised that different sources were using different definitions. Some new studies broke the stages of prevention down further than others, so for depth, I have opted for detail over brevity.
Health, disease, and disability are dynamic processes in an individual’s lifespan and therefore preventative healthcare must be equally dynamic. It is generally agreed that there are four or five categories of interventions considered to be ‘preventative’ and these categories are applied dynamically over time and the progression of the illness (from pre-risk through to chronic conditions, there are preventive services that can help.)
For a quick read, here is an infographic answer to this question. Scroll down for a more detailed look.
1. Primal prevention: A newer category that has arisen from epigenetic research that points to foetal environments as a determination of adult health. Primal preventative measures take place at the very earliest stage of life when a child is still in their mother’s womb. Examples include the promotion of parent health (e.g. stress reduction preventive services and adequate parental leave) which in turn promotes healthy child development that is proven to contribute to a reduction in lifetime illnesses.
2. Primordial prevention: Primordial measures are designed to prevent the development of the risk factors themselves. A risk factor is an early indicator of future diseases, such as smoking and obesity. Primordial prevention, therefore, aims to stop risk factors like these from emerging in the first place. Evidence suggests the earlier in life these interventions are started the better (pre-habit formation) and as a result, primordial prevention tactics are often targeted at the very early stages of an individual’s life.
One example includes a study that gave dietary advice to children in optimal heart health until they were adults which resulted in large reductions in metabolic syndrome in later life. An example that you may have the first-hand experience of is the implementation of mass education through schools (e.g. sex education classes which is a preventive service).
3. Primary prevention: At this stage, risks are already established and preventative interventions are applied to stop risk factors turning into diseases. Primary interventions can be divided into two groups: (1) Health promotion (health education, lifestyle changes, environmental modification, nutritional advice) and, (2) specific prevention provided by primary care professionals like nurse practitioners (vaccinations, immunisation, STI testing). An example of primary preventive services is social prescribing, where individuals identified as lonely or isolated are referred to local agencies or support groups to combat this risk (check out our friends over at BuddyHub who connect lonely elderly people to volunteers in their area.) Another example that most people will have heard of but especially women readers will have come across is cervical cancer screening. Cervical cancer screening is particularly focused on women's health and are a physical exam offered to women over 25 years old that ultimately reduces illness, contributes to wellness and quality of life, and prevents urgent care later in life for many women in the UK.
4. Secondary prevention: These are actions and interventions to stop latent diseases from progressing any further, i.e. to stop a disease currently without symptoms turning into one with symptoms. Screening programmes in the UK, such as breast cancer checks and NHS Health Checks (that screen for cardiovascular illnesses like high blood pressure, heart disease, and kidney disease), are all interventions that catch and tackle diseases early on. To be classified as secondary prevention, the disease needs to be still considered reversible and the intervention take steps to reverse it.
One example of secondary prevention that we have the first-hand experience of at Appt Health is the latent TB vaccination programme. Typically, latent TB infection (LTBI) is carried by individuals born in a country with high rates of TB in the population, and those with LTBI do not appear to have symptoms until suddenly, years later, the dormant infection arises. GP practices in the UK now identify individuals within this ‘high-risk’ group and invite them for a free vaccination to inoculate them, preventing the risk of the more costly and life-affecting TB disease occurring. And, results suggest it’s working, in 2013 there were 7,290 TB cases reported, whereas in 2018 there were just 4,655 reported.
The NHS has several health screening programmes that are targeted towards age groups at-risk of future disease, and they plan to become more precise and targeted with interventions in the coming years. Read more about how population screening works on the NHS website.
5. Tertiary prevention: The last preventative intervention focuses on individuals who have chronic diseases that are symptomatic and non-reversible. Tertiary measures simply aim to limit the further progression of chronic disease or to reduce the effects of disability and maximise remaining capabilities. Examples of preventing more chronic illnesses from progressing could be the use of preventative medicine or it could simply be in-home care by nurses or carers.
Reactive healthcare is simply treatment given in response to a visible symptom, such as mending a broken leg with a cast or prescribing SSRIs for depression.
Overwhelmingly, research and medical products are reactive rather than preventative. Just 5% of the NHS’s budget is spent on measures considered preventative, and health care professionals the world over are traditionally educated in how to treat the consequences of ill-health rather than how to prevent it.
A book could be written on the economic and health benefits of preventative healthcare. The UK government alone has written numerous papers on the importance of preventative health in society over the past 10 years, one prominent example being The Dept. of Health and Social Care’s ‘Prevention is better than a cure’ document that sets out the governments vision for putting prevention at the ‘heart of our nation’s health’.
There are three high level reasons that preventative healthcare is important, and over time we will delve deeper into each on the Appt blog:
(1) To promote individual happiness and well-being. Preventative measures have a long history but are becoming increasingly important as the average life expectancy of an individual increases. To quote the previously linked document, “Whilst we have made great progress in helping people live longer lives, too many of these extra years are spent in poor health. We are now living with more complex illnesses for longer, and significant health inequalities still exist.”
(2) To boost the economy. A healthier population means more people employed and more employed people working productively. Working people in ill-health currently cost the UK economy £100 billion a year due to a reduction in productivity and more days off.
(3) A reduction of pressure on healthcare services like the NHS, social care, and other public services like welfare and crime. Preventing ill-health will reduce the number of people going to visit their GP, requiring secondary care services, and needing social care. Attendance at A&E was up 22% in the past 10 years, and demand is only growing due to an increase in prevalence of people with multiple chronic illnesses. If we don't prevent more ill-health there will be less budget available for unavoidable illness and a growing financial burden place upon the NHS.
Not only does care that's considered preventive reduce health care costs, but public health is also is a major contributor to the reduction of health inequalities. It has been known for a while now that there are large social determinants of health - meaning factors like income are directly correlated with markers like life expectancy. As long as prevention of ill-health is taken up equally across social strata we can be sure it will reduce health inequalities. To reiterate this point, smoking has been identified as the single greatest cause of inequality in death rates between the rich and poor, people from a lower income background are more likely to smoke and less likely to quit so quit smoking services can particular help them.