The concept of prevention: a good idea gone astray?

Abstract

Over time, the definition of prevention has expanded so that its meaning in the context of health services is now unclear. As risk factors are increasingly considered to be the equivalent of ''diseases'' for purposes of intervention, the concept of prevention has lost all practical meaning. This paper reviews the inconsistencies in its utility, and suggests principles that it should follow in the future: a population orientation with explicit consideration of attributable risk, the setting of priorities based on reduction in illness and avoidance of adverse effects, and the imperative to reduce inequities in health.

A aplicação de um guia de medidas preventivas por médicos de família em um centro de saúde de Ribeirão Preto, São Paulo, Brasil

“…Neste cenário, torna-se imprescindível incluir, entre as medidas de PSPD, apenas aquelas que têm indiscutivelmente o apoio da literatura científica. Essa é uma das tarefas dos médicos da ESF, profissionais fundamentais para o sistema público de saúde, visto que 70% dos diagnósticos de câncer são realizados por médicos não oncologistas 18,19 .…”

The payment for performance model and its influence on British general practitioners' principles and practice

“…An example is the municipality of Rio de Janeiro which introduced payment for performance based on the Portuguese model, which in turn was based on the British payment for performance scheme 55 . However, in light of the current evidence, local policy makers when using the payment for performance concept should be careful and target broader quality indicators 6 (or health concepts) 36 for primary care such as rapid access and time working in the same family health team (continuity) -rather than focusing on biomedical markers such as cholesterol, blood pressure and the like -which may reduce some of its unintended consequences by reconciling them with values inherent to family medicine.…”

“…The QOF is also becoming a kind of health-police, for instance searching for "DNA patients" (those who "did not attend") boosted by QOF's comprehensive information technology systems for calling and recalling patients 9 . Other practices promote "zero tolerance" of target failure in order to achieve the desired level or parameters necessary 39 Medicalisation of pre-disease states and risk factors (lowering targets for cholesterol, Hb-1c, and blood pressure) has become increasingly common, raising concern about over-medicalisation 36 . The following general practitioner characterised the effect of QOF on general practice over time as being due to changes in the disease concept whereby what was once a risk factor has now become almost synonymous with disease 36 .…”

Acesso ao cuidado na Estratégia Saúde da Família: equilíbrio entre demanda espontânea e prevenção/promoção da saúde

“…In this sense, Starfield et al (2008) propose two questions. Firstly, is it justifiable that check-up appointments constitute almost half of all visits to health services in the United States, where many people are in need of medical care?…”