What are the 4 types of prevention

By Isabella Storyclaire

last updated September 16, 2024

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Definition/Introduction

The natural history of a disease classifies into five stages: underlying, susceptible, subclinical, clinical, and recovery/disability/death. Corresponding preventive health measures have been grouped into similar stages to target the prevention of thesestages of a disease. These preventive stages are primordial prevention, primary prevention, secondary prevention, and tertiary prevention. Combined, these strategies not only aim to prevent the onset of disease through risk reduction but also downstream complications of a manifested disease.

Primordial Prevention

In 1978, the most recent addition to preventive strategies, primordial prevention, was described. It consists of risk factor reduction targeted towards an entire population through a focus on social and environmental conditions. Such measures typically get promoted through laws and national policy. Because primordial prevention is the earliest prevention modality, it is often aimed at children to decrease as much risk exposure as possible. Primordial prevention targets the underlying stage of natural disease by targeting the underlying social conditions that promote disease onset. An example includes improving access to an urban neighborhood to safe sidewalks to promote physical activity; this, in turn, decreases risk factors for obesity, cardiovascular disease, type 2 diabetes, etc.

Primary Prevention

Primary prevention consists of measures aimed at a susceptible population or individual. The purpose of primary prevention is to prevent a disease from ever occurring. Thus, its target population is healthy individuals. It commonly institutes activities that limit risk exposure or increase the immunity of individuals at risk to prevent a disease from progressing in a susceptible individual to subclinical disease. For example, immunizations are a form of primary prevention.

Secondary Prevention

Secondary prevention emphasizes early disease detection, and its target is healthy-appearing individuals with subclinical forms of the disease. The subclinical disease consists of pathologic changes but no overt symptoms that are diagnosable in a doctor's visit. Secondary prevention often occurs in the form of screenings. For example, a Papanicolaou (Pap) smear is a form of secondary prevention aimed to diagnose cervical cancer in its subclinical state before progression.

Tertiary Prevention

Tertiary prevention targets both the clinical and outcome stages of a disease. It is implemented in symptomatic patients and aims to reduce the severity of the disease as well as any associated sequelae. While secondary prevention seeks to prevent the onset of illness, tertiary prevention aims to reduce the effects of the disease once established in an individual. Forms of tertiary prevention are commonly rehabilitation efforts.

Quaternary Prevention

According to the Wonca International Dictionary for General/Family Practice, quaternary prevention is "action taken to identify patients at risk of overmedicalization, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable." Marc Jamoulle initially proposed this concept, and the targets were mainly patients with illness but without the disease. The definition has undergone recent modification as "an action taken to protect individuals (persons/patients) from medical interventions that are likely to cause more harm than good." [1]

Issues of Concern

In the United States, several governing bodies make prevention recommendations. For example, the United States Preventive Services Task Force (USPSTF) is a governing body that makes recommendations for primary and secondary prevention strategies. The Advisory Committee on Immunizations Practices (ACIP) through the Centers for Disease Control and Prevention (CDC) makes recommendations for vaccinations, while the Womens Preventive Services Initiative (WPSI) makes recommendations appropriate for females. Additionally, various specialty organizations, such as the American College of Obstetrics and Gynecology (ACOG) and the American Cancer Society (ACS), etc. also make prevention recommendations. With the multitude of information and recommending bodies, it is often challenging for healthcare professionals to remain up to date on changing endorsements.

Further, while preventive services are regulated and must undergo scrutinous safety testing, there is risk involved with prevention. Particularly primary and secondary preventive factors targeted at intervening in healthy-appearing individuals. It is often challenging to gain buy-in from patients regarding the risk-benefit ratio of various preventive services.

Finally, the cost of preventive services is commonly a topic of discussion. Several cost-benefit analyses have been undertaken regarding the evaluation of preventive services with varying degrees of confidence. While often a long-term gain of healthy life years is noted, preventive services are not inexpensive, which can limit the use of these services by both healthcare systems and patients and is a consideration when promoting preventive services.

Clinical Significance

Preventive services have proven an essential aspect of healthcare; however, they appear consistently underutilized in the United States.[2][3][4] With cost, time, and resource constraints on physicians, many preventive services get overlooked. Physicians need to remain up to date on the prevention guidelines and ensure all patients are offered appropriate services with a full explanation of risks and benefits.

Some examples of commonly used prevention strategies are:

Primordial

Primary

Secondary

Tertiary

Quarternary

The following conditions are susceptible to over-treatment:

Radiological incidentalomas
[9]
The use of antiarrhythmic drugs after myocardial infarction that reduced arrhythmias but increased mortality
The use of hormone replacement therapy led to an increased number of cases of breast cancer, stroke, and thromboembolic events. It was also a failure in reducing cardiovascular mortality.
Medically unexplained symptoms
Functional disorders
Bodily distress syndrome
[10]

Nursing, Allied Health, and Interprofessional Team Interventions

Proper communication among the various healthcare personnel should be there to provide appropriate levels of prevention to the general public and patients. School staff and other ancillary staff require education on the importance of providing prevention as an important aspect of caring for an individual while he/she is a student.

The 4 Primary Food Safety Hazards and Preventing Foodborne Illness

September is National Food Safety Education Month, and we wanted to highlight methods for implementing safer food practices. The CDC has reported that 48 million people per year get sick from a foodborne illness, many of which are preventable. It is important for food service professionals to be aware of the primary types of food safety hazards, and the best methods of prevention.

Food Safety Hazards

There are four primary categories of food safety hazards to consider: biological, chemical, physical, and allergenic. Understanding the risks associated with each can dramatically reduce the potential of a foodborne illness. Each have their own unique characteristics, but all can be avoided through a robust food safety management system (FSMS).

Biological Hazards

Biological hazards are characterized by the contamination of food by microorganisms. Found in the air, food, water, animals, and in the human body, these incredibly tiny organisms are not inherently unsafe many provide benefits to our anatomy. Despite this, foodborne illness can occur if harmful microorganisms make their way into the food we eat. There are several types of microorganisms, each of which can negatively impact health: bacteria, viruses, and parasites.

Bacteria colonies on a petri dish

There are a variety of factors that influence dangerous microorganism growth, including temperature, pH levels, and moisture of the food. The USDA has coined a term for the temperature range that encourages bacterial growth: the Danger Zone. This temperature range, 40 F 140 F, enables bacteria to grow most rapidly, nearly doubling its number in 20 minutes. In addition, the pH level of a food, or its acidity, can accelerate growth. Foods that are less acidic, such as milk, tend to foster bacteria at higher rates than more acidic foods, like lemon juice. Microbes prefer warmer, wetter environments, which make moist foods hotbeds for microorganism growth.

Biological Hazard Examples

Biological Hazard	Commonly found in
Salmonella	Eggs, poultry, meat, unpasteurized milk or juice, cheese, fruits and vegetables, spices, and nuts
Norovirus	Produce, shellfish, ready-to-eat foods
Campylobacter	Raw and undercooked poultry, unpasteurized milk, contaminated water
E. coli	Undercooked ground beef, unpasteurized milk or juice, raw milk cheeses, raw fruits and vegetables, contaminated water
Listeria	Ready-to-eat deli meats and hot dogs, unpasteurized milk or juice, raw milk cheeses
Clostridium perfringens	Beef, poultry, gravies

Biological Hazard Prevention

The best way to prevent biological hazards from affecting customers is to implement robust processing and storage strategies. Kill steps used prior to packaging is necessary, such as cooking thoroughly or pasteurization of milk and juices. Use of packaging technologies during processing like vacuum sealing hinders bacterial growth. Proper temperature management for storage can dramatically reduce microbe growth. Finally, effective sanitation practices throughout the distribution chain will reduce cross-contamination of food products.

Chemical Hazards

Chemical hazards are identified by the presence of harmful substances that can be found in food naturally, or unintentionally added during processing. Some chemical hazards include naturally occurring chemicals, such as mycotoxins, intentionally added chemicals, including the preservative sodium nitrate, and unintentionally added chemicals, like pesticides.

Tractor spraying pesticide, which can inadvertently find its way into the food we consume

Chemical Hazards Examples

Chemical Hazard	Examples
Mycotoxins	Produced by fungi and can be toxic to humans and animals. They are formed by moulds which grow on crops and foods under certain conditions.
Natural Toxins	Biochemical compounds produced by plants in response to certain conditions or stressors.
Marine Toxins	Decomposition or microscopic marine algae accumulated in fish and shellfish.
Environmental Contaminants	Accidentally or deliberately enter the environment. Typically manufactured for industrial use.
Food Additives	Any chemical substance that is added to food during preparation or storage.
Processing-induced Chemicals	Undesirable chemicals can be formed in certain foods during processing as a result of reactions between compounds that are natural components of the food.
Pesticides/Agricultural Products	Used to control, destroy, or repel a pest, or to mitigate the effects of a pest.
Veterinary Drug Residues	Used in food-producing animals to control and/or prevent illness in the animal.

Chemical Hazards Prevention

Similar to preventing biological hazards, proper cleaning procedures and sanitation requirements are the best methods of prevention. Training employees to follow strict guidelines is essential in preventing a chemical hazard. Additionally, limiting the use of chemicals to those generally recognized as safe (GRAS),and ensuring that chemicals are stored in designated areas separated from food products.

Physical Hazards

Physical hazards are foreign objects that are found in food products. They are either naturally found in the specific item, such as stems in fruit, or not normally part of the food item, such as hair or plastic. Unnatural physical hazards are generally more dangerous to health, whereas natural physical hazards can be harmless.

Recently, sewing needles were maliciously inserted in strawberries throughout Australia

Physical Hazards Examples

Physical Hazard	Examples
Unnatural	Insects, hair, metal fragments, pieces of plastic, wood chips, and glass
Natural	Stems in blueberries, microscopic airborne debris, dirt on potatoes, or minute insect fragments in figs

Physical Hazards Prevention

Prevention of physical hazards focus primarily on thorough inspection of food, and strict adherence to food safety regulations, such as Hazard Analysis Critical Control Point (HACCP) discussed below. Organizations can also take proactive steps in eliminating the potential of a physical hazard. Light bulbs, for instance, can be manufactured using different materials. Acrylic is both lighter and stronger than glass, and tends to shatter into larger, blunter fragments than glass.

Allergenic Hazards

The final, and perhaps the most deadly, are allergenic hazards. Allergies are the 6th leading cause of chronic illness in the U.S., with more than 50 million people suffering from allergies each year. Allergic reactions occur when the human body produces an abnormal immune response to specific proteins found in food.

Source: https://www.owensborohealth.org/services/community-wellness--education/nutrition-weight-management-/food-allergies/

Allergenic Hazards

Allergenic Hazard	Commonly found in
Milk	Butter, cheese, cream, milk powders, and yogurt
Eggs	Cakes, some meat products, mayonnaise, mousse, pasta, quiche, sauces, and foods brushed with egg
Nuts	Breads, biscuits, crackers, desserts, ice cream, marzipan, nut oils, sauces, and curries or stir fries
Soy	Desserts, ice cream, sauces, and vegetarian products
Wheat	Baking powders, batter, breadcrumbs, brea, cakes, couscous, pasta, pastries, sauces, soups, and foods dusted with flour
Fish	Fish sauces, pizzas, relishes, salad dressings, stock cubes, and Worcestershire sauce
Shellfish	Shrimp paste, and curries or salads

Prevention

Unfortunately there is no way to prevent allergies, but it is possible to reduce the risk of an allergic reaction. So long as companies embrace proper sanitation techniques and present potential allergenic ingredients obviously on product packaging, allergic reactions will be minimized. Preventing an allergic reaction falls primarily on the consumer, but they can only do so effectively if businesses do their part with effective sanitation and labeling of ingredients.

Regulations and Laws

Regulatory bodies including the Food and Drug Administration (FDA) and the United States Department of Agriculture (USDA) have implemented laws that help minimize food safety risk and ensure safer food safety practices. In doing so, food safety practices have become significantly more robust and effective.

Hazard Analysis Critical Control Point (HACCP)

HACCP, implemented in 1997, changed food safety methodology to be science-based as opposed to conventional sight, smell, and touch inspection. HACCPs core principles provides a means to analyze biological, chemical, and physical hazards along the supply chain. This prevents outbreaks before they can occur rather than responding to them after the fact, and helped to accelerate technology used to manage food safety. Foodborne illnesses reduced dramatically as a result of HACCP.

Food Safety Modernization Act (FSMA)

Similar to HACCP, FSMA has enabled additional methods of preventing food contamination. The Sanitary Transportation of Human and Animal Food has three methods of preventing foodborne illness: vehicles and transportation operations must validate temperatures in transit, staff must be trained properly to prevent practices that create food safety risk, and new record keeping requirements created efficient mechanisms to demonstrate proper temperature control. Through proactive management of food safety, distributors are better equipped to prevent foodborne illness.