The practice of preventive medicine by the doctor

What is preventable?

The first step in the implementation of prevention is to define which specific diseases can be prevented and to what extent, given certain restraints such as human resources, technology and the cost to the community. All diseases have a potential preventability but it may be unrealistic to try to achieve this.

Diseases that can be prevented can be grouped according to their aetiology. They fall into the following broad categories:

• genetic disorders

• conditions occurring during pregnancy and the puerperium

• developmental disorders

• infections

• addictions

• behavioural disorders

• occupational disorders

• premature vascular disease

• handicap in the disabled

• certain 'other' diseases, e.g. diverticular disease

Mortality is the only reliable index by which the outcome of preventive activities can be judged. Conditions can be ranked in importance as causes of premature death according to the 'person years of life lost before 70 years' as follows: 1

Accidents, poisoning and violence 29%

Neoplasms 19%

Circulatory diseases 17%

Perinatal conditions 10%

Congenital conditions 7%

This gives quite a different perspective to prevention and explains why the efforts of public health authorities and practising doctors do not always coincide.

The interventions available to us in medical practice are as follows:

1. educational—health promotion, health education and illness education

2. screening

3. surveillance

4. interventional care—immunisation, behaviour modification and drug prophylaxis

5. Rehabilitation

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