Primordial
Primordial prevention entails, “risk factor reduction targeted towards an entire population through a focus on social and environmental conditions.”
- Regulating the sale of unhealthy products
- Banning smoking in indoor areas
- Improving public transport or walking infrastructure to reduce car reliance
Primary
Primary prevention is targeted at people before they develop an illness.
- Social prescribing (eg of exercise)
- Information and awareness to enable people to make healthier choices
- Immunisation and vaccination
- Food supplements
- Addiction / help-to-quit services
Secondary
Secondary prevention entails, “early detection when this improves the chances for positive health outcomes.
- Screening
- Preventive medication
- Timely diagnosis
Tertiary
Tertiary prevention is targeted at symptomatic patients.
- Rehabilitation
- Walking aids to prevent falls
- Medication to manage symptoms or slow progression
CancerWatch is concerned with all forms of prevention, and we believe that the wider cancer charity sector’s focus on prevention gets stronger the further one looks down the hierarchy from primordial to tertiary, with many charities placing heavy emphasis on services but the emphasis on structural change being lighter and less common.
The sector is not alone in this: public policy as a whole has been much more strongly focused, over the long term, on the tertiary end of the range rather than the primordial. And when prevention has been prioritised, it has typically been in the form of primary prevention aimed at the individual, not primordial prevention aimed at society as a whole.
In the Government’s announcement of its Major Conditions strategy for England there is a strong focus on primary prevention. It proposes new measures to help people stop smoking, extra funding for drug and alcohol recovery treatment, the introduction of new weight loss drugs and an app-based incentives system for helping individuals to make healthier choices. These prevention measures are in the context of more extensive chapters on changes to the delivery of care and treatment.
But it is silent on primordial prevention: it does not propose any new measures on reformulating products to reduce sugar, salt or calorie content; it does not propose further restrictions on the sale or consumption of tobacco; it does not propose minimum unit pricing for alcohol; it does not propose any greater regulation of the sale of unhealthy takeaway food.
What’s more, it has been issued in place of a white paper on health inequalities, which would have been expected to home in on the underlying structural causes of health inequalities much more acutely.
This relatively weak approach to prevention, understanding it in terms of changing individual behaviour (primary prevention) but not attempting any structural change to tackle root causes (primordial prevention) exhibits continuity with long term policy approaches, particularly (but not exclusively) in England.