Prevention paradox

Rose, Geoffrey

If many individuals with low risk (e.g. borderline hypertension, slightly conspicuous cholesterol levels, pre-diabetes) take a preventive measure, this usually benefits the entire population. In a large number of people, cardiovascular disease events or premature death are reduced in the long term.

However, a low-risk individual will rarely experience a direct benefit through short- or medium-term improvements in health or by extending their disability-free life.

The situation is different for preventive measures in small groups at high risk, e.g. clinically obese people or patients with manifest hypertension, hypercholesterolemia or type II diabetes mellitus. Here, the individual health gain through early detection, early treatment and tertiary prevention is disproportionately higher than in people at medium and lower risk. However, there is no comparable effect for the overall population.

The prevention paradox applies to all medical interventions and objectives based on risk factors, especially to behavioural prevention measures. Typical application examples in the field of medicine are:

• dietary and lifestyle recommendations and/or drug interventions aimed at reducing cholesterol, blood pressure or blood sugar levels
• Screenings for undetected hypertension for the prophylaxis of infarcts, diabetes screenings, skin cancer screening, PSA blood tests for the early detection of prostate cancer,
• invasive early detection measures such as colonoscopy for the prevention of colon cancer.

1. Franzkowiak, P (2018) The prevention paradox - key concepts of health promotion - BZgA doi: 10.17623/BZGA:224-i094-1.0