With regard to health promotion and prevention of disease there are basically three tiers. Health care debate often develops around these three tiers.
The three levels of prevention are usually referred to as primary, secondary and tertiary and can be explained this way.
Primary is meant to stop disease or injury from occurring. This includes using seat belts, helmets, sunscreen, adopting a healthy diet, engaging in regular exercise and receiving vaccines.
Secondary is to cure the problem, fix the injury and prevent any chronicity or long term disease and disability. Here a person may lose weight to avoid having to go on prescription medication or wear a cast to heal a fracture. In some cases this stage does involve long term use of medication but the goal is to cure the disease if at all possible. Both this level and the one above can include health promotion and health educators as sources of expertise.
Tertiary really isn’t prevention in my mind except that it strives to prevent pain and despair. This is treatment of disease to prolong life and add quality years if possible while providing comfort. There is effort to prevent further decline or spread of disease, though it is not as effective in this stage as it would be in stage two when caught early. Many times this will include high cost cancer treatments, surgery interventions, even loss of limbs and or organs to prevent disease progression or death. For example, a person with uncontrolled diabetes may require an amputation. A person who had a heart attack and did not follow treatment recommendations in stage two may now need a pace maker or stent placement. In this stage there is also effort to preserve independence and functioning. This level is very clinical and health educators may be replaced with nurse case managers to ensure treatment compliance or Hospice initiation.
As you can see, the numbers of person targeted in each stage is going to be different and the cost of the intervention will be different. Thus, the ROI or return on investment varies and is the interest of many a health economist and congress person.
An example for each level:
1-A simple PSA broadcast nationally, for example “Lose the Juice” or “1% or Less is Best” does not cost very much and can reach millions of people. However, it may not change as many people as a more intense or tailored message would or it may not reach the people who most need to change.
2-A health screening may identify pre hypertension or untreated hypertension which could get those persons into care to stop a problem from developing. This is more costly up front, but could save billions in the end. Questions about general screenings include how to handle false positives and referrals for care, especially in the uninsured. Cholesterol checks at health fairs would also fall into this category as would a general class on nutrition.
3-A chemotherapy drug or surgical procedure to treat smoking related lung cancer is extremely costly, may not prolong life and is invasive to the individual. This is expected to cost the most money for the fewest amount of people. Unfortunately, things are changing somewhat and more and more people do end up at this level because of the devastating and mounting consequences of obesity in our youth.
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Still, all things considered… what if the cost of primary prevention equaled the cost of tertiary prevention… we could skip the first level yes? Actually, no. The use of resources and the high emotional and physical cost to the patient is NOT ACCEPTABLE. Of course, level three clearly does cost more and will only grow in the near future. We do have the ability to prevent disease and thus prevent suffering. We have the ability to add quality life years and it would be unethical to shirk that responsibility.
Just as the public health arena or the government has the responsibility to provide preventative measures to the citizens of this country... so do the individual citizens have the responsibility to heed recommendations. We are all in this together and if we want to keep costs AND disability down, we must take care of ourselves. So yes, regulation does come into play. seat belt laws, tobacco use laws, taxes on junk food, mandated health insurance… it all promotes health, physical and financial.
as I finish this post... our President speaks......
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