Dr Michael Barnish
Preventative Health simply refers to anticipatory measures or interventions taken to prevent disease or ageing. Health, disease, and disability are dynamic processes in an individual’s life and therefore preventative healthcare must be equally dynamic, adaptable to the changes that occur. Preventative health is not traditionally a recognised specialty in many health authorities and doctors, like me, who dedicate their career to this specialty are few on the ground and fighting against a very conventional model of medicine, that often disregards the importance of this specialty, whether that consciously or subconsciously.
Reactive vs Preventative Healthcare.
Reactive healthcare describes treatment that is given in response to a visible symptom, such as prescribing a medicine for depression or newly diagnosed diabetes. Preventative healthcare focuses on applying the science to prevent symptoms of disease occurring before the symptoms arise. Of course, this can still be applicable for those with disease and symptoms already. In this instance, preventative healthcare is more focused around preventing symptom and disease progression. This, in turn, supports regenerative medicine, another important area of healthcare that is emerging.
Standard medical practice, around the world, overwhelmingly favours a reactive model. Research and development in medicine is largely based around the reactive approach. In the UK for example, it is estimated that only 5% of the NHS’s budget is spent on measures considered preventative.
Medical training continues to be centred around reactive approaches. This training pathway alone sets medical professionals up to almost dismiss the preventative aspect of medicine, largely due to it being played down as a secondary adjunct to medical care.
Preventative Health: The different areas of focus.
Primal prevention is the area of preventative medicine that intervenes at a foetal level. With epigenetics being biology’s most exciting field, vast amounts of knowledge have arisen, to allow medical professionals to correctly advise and intervene potential mothers and father at the earliest stages of life, or perhaps even before. Epigenetic influences, such as stress, diet and environment all play a role on the next generations genome. Interventions under guidance can alleviate negative lifestyle situations at these early stages of conception and foetal development to steer the health of the baby in a positive direction.
Primordial interventions aim to prevent the occurrence of the risk factors involved in a specific condition. Risk factors are usually well established for many diseases and primordial prevention focuses on avoiding these. Through education, often best at an early age, primordial prevention occurs by ensuring the individual does not gain weight as they have been educated on how to eat well, or they don’t take up smoking as they are aware of the dangers. Therefore, the risk factor is avoided.
Primary prevention focuses on the areas of health promotion & screening and vaccination. Health education across the world is generally quite poor. We still are waiting for strong health education curriculum’s to be built into mainstream learning within school education systems. Marketing campaigns fill our screens and devices, promoting foods and behaviours that promote poor health. Where are the global campaigns that promote positive health behaviours, telling you not to pick up a bottle of cola or a very sugary breakfast bar? They don’t exist yet. Medical education is one of the most important pillars of preventative health. The world needs to do better.
Screening programmes are well established in most countries now. However, there are limitations to these, and they are not available to all, often with specific groups of people eligible for the service. Screening programmes are only usually adopted when there is a cost benefit to the health care provider. That makes sense, but screening shouldn’t be limited to those groups. People should be aware that they have the option of screening and surveillance. A shift is happening and if people take the opportunity to have their bloods taken regularly throughout the year, and not just in reaction to a symptom, diseases would be caught earlier, and better prognosis can occur. If you are lucky enough to have a free screening service, then take it. It is an excellent way to look after your health.
Vaccination is another great example of primary prevention and an effective way of preventing infectious disease. Most nations offer excellent vaccination programmes, often in the early years of life. However, similarly to screening, you may have to be in a specific group to qualify for them routinely. None-routine vaccination can help protect health during travel, in certain occupations and in higher risk exposure.
Unfortunately, as a preventive health specialist doctor, I practise this area of preventive medicine the most. Secondary prevention refers to actions and interventions to stop already established diseases from progressing any further. Screening crosses over the boundary here a little as some screening interventions aim to catch disease early. To be officially classified as a secondary prevention intervention, the disease needs to be considered reversible. However, there are many diseases, deemed irreversible, where secondary prevention is still vital, in my opinion. Interventions can often help to control symptoms, slow progression and improve the patient’s quality of life in many situations.
When a disease is classified as irreversible then interventions used with this group of individuals are deemed tertiary prevention. These interventions can often help to control symptoms, slow progression and improve the patient’s quality of life in many situations. The applications of medicines, supplements and changing lifestyle behaviours, with this group of individuals, are good examples of this area of prevention.
Making the shift.
Preventative strategies need to improve around the world. With increasing chemical environments, poor lifestyle choices and food lacking in nutrition, health is deteriorating, and obesity rates are increasing. Action must be taken, soon, and preventive measures are the most economical and practical way to safeguard our future health. In the UK, alone, we are seeing a potential economic cost of around £100 billion per year from the impact of ill health on working individuals.
We are seeing some change. In 2018, the UK government published their ‘Prevention is better than a cure’ document outlining a strategy to improve healthy life expectancy by at least 5 extra years, by 2035, and to close the gap between the richest and poorest. All very excellent goals, but two years in, I have yet to witness any big changes. Other nations are beginning to make small steps in a positive direction. In the meantime, there are a small number of doctors and other medical professionals, trying to educate and carve out a recognised preventative health medical specialty.