Levels of Disease, Illness, and Accident Prevention

Normally, we think of disease prevention as steps taken before the illness begins. But, actually, there are three levels of prevention and treatment medical staff undertake:

• Primary
• Secondary
• Tertiary

These are actions taken before a disease or accident occurs in an effort to prevent it. Examples are:

• Eating healthy meals
• Exercising
• Avoiding smoking
• Wearing seatbelts
• Sleeping adequately (See: How Sleep Deprivation Affects Your Health)
• Seeking regular medical advice and testing

These are actions taken early in the process of an illness. For instance, if you are diagnosed with high blood pressure, the illness is identified, treated (regular testing, monitoring, taking prescribed medications), and (hopefully) lifestyle changes (dietary and exercise-related) are made.

Once a disease has progressed, tertiary treatment seeks to contain or regress the problem. For example, in the case of cancer, experts may administer radiation and chemotherapy in an attempt to return the patient to a complete or relative state of health.

Although tertiary treatments are more expensive than primary and secondary prevention, we tend to be more highly motivated to comply with tertiary treatments since the results are more immediate and obvious.

• Doctors and other health care providers traditionally spend more patient time, effort, and education on tertiary treatments.
• During the period of our lives when we're developing independent health habits (teen to early adulthood), smoking, eating high fat diets, and avoiding exercise can be enjoyable, and the effects are not immediately obvious to our health and appearance. So, we have no incentive to correct poor health habits. These habits can become entrenched and harder to break in years to come.
• High-risk sexual behavior is an example of how delayed visible consequences delay intervention. Within 3-6 weeks of contracting HIV, the only results noticed may be slight cold-like symptoms. But, the incubation period can last up to 20 years. The lack of immediate visible repercussions of the disease provides no incentive to give up the risky behavior.

Proponents of family and community-based education aimed at primary and secondary prevention have received mixed results.

. . . in some ways for the better, in some ways for the worse. Some insurance companies are placing severe restrictions on approved doctors, procedures, testing, and reimbursement for other charges.

But, some insurance companies (example: Kaiser Permanente) realize that prevention, after all is said and done, is less expensive than tertiary care, taking time and money restrictions out of the pursuit of good health. Most doctors will readily admit that it takes much more time to discuss and maintain preventative health to patients (primary prevention) than prescribing a pill for the symptoms of an existing ailment (tertiary treatment).

One exemplary philosophy of a preventative physician, Dr. Neil Singer, M.D., as he approaches his patients in the following way, is described on his website: Primary prevention in my practice involves everything possible to keep every patient as healthy as possible and in either preventing disease in the first place or delaying the progression of already established disease. This involves, among other things, obtaining an extensive medical history, ordering extensive and advanced blood work, having patients complete extensive questionnaires on a variety of subjects, performing screening examinations in the office, doing a complete physical exam and discussing the results of that exam and the blood work, discussing strategies to avoid disease, and mailing out a summary of my findings to the patients. The above is performed every year on every patient in my practice. It is only is this manner that primary prevention can be truly practiced.