Dr. Smith was working at the health center. She started to notice a lot of patients coming in with a red pustular rash over the entire body. The rash resolved with steroids, and if untreated caused severe scarring. It seemed like an allergy, but she could not figure out to what. She started a program to reach out to the community to screen for the rash and encourage them to come in for treatment before it caused scars to form. The rash was chronic and needed continued treatment.
As more and more people began to come in, she noticed that most patients had been on weekend trips to the park in town. She couldn’t figure out what the source was, but she began a program at the park to screen for the start of this rash and refer them to treatment. It seemed like early treatment was able to cure the rash.
From these patients, she learned that most had gone swimming in the local river. Most of the swimmers did not get the rash, but it was found that those with the rash had spent several hours over the weekend in the water. Eventually, she traced the source to a company upstream that had been releasing byproducts thought to be safe into the water. Research showed that these byproducts were causing the rash. The company was notified and their scientists found a safer way to break down the byproducts so that they would not be toxic to the skin. There were no more rashes reported.
This fictitious case presentation demonstrates various levels of prevention. (Similarities to any real cases are purely coincidence.)
“Screening” is often promoted as the only way to “prevent” disease by early detection and treatment. However, knowing the levels of prevention, helps us chase the source of the problem “upstream” (as in the example case above). Healthy lifestyle habits of healthy diet, exercise, sleep, and stress management are prevention. In fact, they are primary prevention!
Primary Prevention
The “upstream” company was stopped from releasing toxic byproducts into the water. Disease or injury is prevented before it has even occurred.
Example: brushing your teeth, seat belts, smoking cessation
Secondary Prevention
Outreach into the high risk people attending the park, rashes were detected early, treated early, and cured. The impact of a disease or injury is minimized after it has occurred.
Example: mammograms for screening and detection of early breast cancer
Tertiary Prevention
Reaching out to the community for people with this full body rash to present for treatment to minimize scarring. A chronic long-term disease process or injury is managed to improve function, quality of life, or life expectancy.
Example: screening for severe diabetes requiring chronic medications, support groups for depression
Levels of Prevention
In most cases, as a society, all three levels of prevention are needed.
And whenever possible, primary prevention…. Eat your veggies. Avoid processed foods. Stop smoking. Avoid a sedentary lifestyle. Exercise. Get enough sleep. Find passion and purpose in what you do. Create healthy connections. Use healthy stress management techniques. Lifestyle Medicine.