In 2013, the United States spent $2.9 trillion on health care. Only 2.6% of this total was dedicated to government public health activities designed to prevent illness.
The renowned medical historian Henry Sigerist, writing in 1941, listed the main items that must be included in a national health program. The first three items were free education, including health education, for all; the best possible working and living conditions; and the best possible means of rest and recreation. Medical care rated only fourth on his list (Terris, 1992a). For Sigerist (1941), medical care was
A system of health institutions and medical personnel, available to all, responsible for the people’s health, ready and able to advise and help them in the maintenance of health and in its restoration when prevention has broken down (Sigerist, 1941).
Many people working in the fields of medical care and public health believe that “prevention has broken down” too often because society has dedicated insufficient resources and commitment to prevention.
Primary prevention seeks to avert the occurrence of a disease or injury (e.g., immunization against polio; taxes on the sale of cigarettes to reduce their affordability, and thereby their use). Secondary prevention refers to early detection of a disease process and intervention to reverse or retard the condition from progressing (e.g., Pap smears to screen for premalignant and malignant lesions of the cervix, and mammograms for early detection of breast cancer).
The promotion of good health and the prevention of illness encompass three distinct levels or strategies (Terris, 1986; Table 11-1):
Table 11-1Strategies of prevention |Favorite Table|Download (.pdf) Table 11-1 Strategies of prevention
|1. Improvement in the standard of living ||Job creation |
Increase in minimum wage
|2. Public health interventions to reduce the incidence of illness in the population ||Water purification systems in underdeveloped nations |
Increased tobacco taxes to reduce the purchase of cigarettes
Mass education on the dangers of high-fat diets
|3. Preventive medical care, performed by health care providers ||Screening and treatment of hypertension |
Periodic breast examinations and mammograms
The first and broadest level includes measures to address the fundamental social determinants of illness; as evidence presented in Chapter 3 shows, lower income is associated with higher morbidity and mortality rates. Improvement in the standard of living and social equity (e.g., through job creation programs to reduce or eliminate unemployment) may have a greater impact on preventing disease than specific public health programs or medical care services.
The second level of prevention involves public health interventions to reduce the incidence of illness in the population as a whole. Examples are water purification systems, the banning of cigarette smoking in the workplace, and public health education on human immunodeficiency virus (HIV) prevention in the schools. These ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPhysiotherapy Full Site: One-Year Subscription
Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.
Pay Per View: Timed Access to all of AccessPhysiotherapy
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.