Putting prevention at the heart of public health
Posted on 10 January 2024 by Paul Johnston
- Population health
We talk about prevention a lot at PHS, and for good reason. In essence, prevention in public health is about keeping people healthy and avoiding the risk of poor health, illness, injury, and early death. Most organisations are familiar with the idea of prevention but when they talk about it, they often use the same language to talk about different things. That creates confusion which can act as a barrier to investment. It’s something we want to change.
By 2043, the burden of disease in Scotland is forecast to increase 21%. Two thirds of this increase will be due to increases in cancers, cardiovascular disease, and neurological conditions. Failing to tackle issues now will lead to more serious problems in future. Something needs to change to help meet the shifting demands of our ageing population.
Success so far
We know prevention can work:
Minimum Unit Pricing (MUP): estimated reduced alcohol hospital admissions (4.1%) and deaths due to alcohol (13.4%) from 2018 to 2020
COVID-19 vaccines: More than 27,656 deaths were directly prevented in Scotland by COVID-19 vaccines
Smoking ban: reduced admission for child asthma (18%) and heart attacks (17%)
Childsmile: halved tooth decay amongst children between 2003 and 2020.
Three levels of prevention
Getting prevention right means that we should be clear about what we mean. Public health recognises three types of prevention as central to addressing poor outcomes.
Primary prevention is action that tries to stop problems happening.
Secondary prevention is action which focuses on early detection of a problem.
Tertiary prevention is action that attempts to minimise the harm of a problem through careful management.
Most preventative action focuses on finding people with health problems and helping them before the problem gets worse. Only primary prevention tries to stop the problems from happening.
Building blocks of health
Public Policy Research (IPPR), for example, suggest that £2.3 billion of health boards’ budgets is being directed at responding to the impacts of poverty. It’s clear that there is a role for prevention in changing the way we prioritise the spend of public money, with new ideas emerging which could, if adopted, fundamentally change the way the public sector operates.
Prevention is a way of working that needs long-term commitment. This will involve action across social and economic factors; health behaviours; health services; and in the places in which our communities live and work. By persevering, the evidence suggests we could see significant reductions in Scotland’s longstanding health challenges, increased life expectancy, and a narrowing of health inequalities.