Prevention in medicine

Prevention in medicine (in short: prevention) attempts to maintain or improve the health status of the population, population groups or individuals. The corresponding branch of medicine is called preventive medicine. In various fields (e.g. dentistry and oncology) the term "prophylaxis" is used synonymously with the term "prevention".

The central strategy of prevention is to push back the triggering factors of diseases in the present or to eliminate them completely in order to avoid undesired consequences in the future. Preventive measures are usually long-term in nature and aim at permanent changes in attitude, experience and behaviour. Disease prevention is not only understood as a task of medicine. Rather, it can only be implemented on an interdisciplinary basis with the participation of psychologists, sociologists, pedagogues and others.

Classification according to the time of intervention (according to Caplan 1964):

Prevention and prevention measures can be classified as follows:

• primary (primary prevention)
• secondary (secondary prevention)
• tertiary (tertiary prevention)
• Quaternary prevention (Marc Jamoulle 1986).

Primary prevention begins before the onset of the disease and aims to reduce the incidence of disease. Primary prevention is aimed at risk groups, healthy people and people without symptoms. Examples of primary prevention are measures for healthy nutrition, sport, stress management or addiction prevention.

Secondary prevention is the early detection of diseases, the prevention of their progression or chronification. The target group are apparently healthy persons, for whom the disease only becomes evident through a suitable diagnostic procedure. Examples are screening procedures for skin cancer, breast cancer or colon cancer; preventive measures for children or pregnant women.

Tertiary prevention takes place after acute treatment or after manifestation of a disease. It is intended to prevent consequential damage and relapses. Tertiary prevention is aimed at patients with chronic impairments and diseases (e.g. atopic dermatitis, bronchial asthma). The concept of tertiary prevention is largely the same as that of rehabilitation.

Quaternary prevention aims to prevent unnecessary medication and overmedication according to the principle of "primum non nocere". Elderly people in particular are affected by multi-medication.

Essentially, all prevention methods can be traced back to the following methods:

Strengthening the motivation and health competence of people with the aim of reducing behaviour that is harmful to health and strengthening behaviour that promotes health.

Measures taken by the legislator to enforce preventive behaviour with the help of laws and regulations, as well as appropriate sanctioning measures.

Economic incentive and "punishment" systems to influence individual behaviour and conditions in a preventive way.

Preventive measures in medicine have both ethical and economic reasons: individual suffering should be prevented as far as possible, the quality of life of people and thus their ability to work should be improved (example: occupational dermatology) and life itself should be prolonged. At the same time, prevention is intended to reduce the economic burden of treatment that would then become superfluous. Disease prevention usually begins before the onset of a disease and is therefore different from cure or therapy.

Prevention and health promotion are of different but complementary nature. The common goal of the measures is to improve and maintain health. Health promotion (salutogenesis) is aimed at directing the position of the individual towards health. The basic question here is: What keeps you healthy?

Health promotion: A distinction must be made between the concept of prevention and that of health promotion, which is based on the Antonovsky model of salutogenesis (WHO Ottawa Charter, 1986). Whereas prevention is about reducing and avoiding risk factors, health promotion is aimed at promoting protective factors and strengthening health-related living conditions.

Organisations in Germany: In the Federal Republic of Germany, public, private and scientific organisations carry out comprehensive prevention work for the benefit of the population, e.g.:

• Professional Association of German Preventologists
• Federal Association for Prevention and Health Promotion (BVPG)
• German Society for Social Medicine and Prevention
• Scientific Institute for Prevention in Public Health (WIPIG)

1. Peter Franzkowiak: Prevention and disease prevention. In: Federal Centre for Health Education (Ed.): Key terms of health promotion, doi:10.17623/BZGA:224-i091-1.0
2. Abholz HH (2006): Hausärztliche Prävention - Ein Vorschlag für eine Systematik. Journal of General Medicine 82: 50-55

• Normalization of blood pressure: normotensive patients live about 5 years longer than hypertensive patients.
• nicotine abstinence: on average, smokers die 10 years earlier than non-smokers
• Weight loss: BMI 22,5-25kg/m2 = lowest mortality; BMI 30-34,9kg/m2 = 2-4 years loss of life; BMI > 40kg/m2 = 10-12 years loss of life.
• Mediterranean diet: heart attack rate = -40-50
• Regular exercise (15 min./day): Heart attack rate = -40-50