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edition in 2006, that the World Health Organization (WHO) released the textbook
Basic Epidemiology (Bonita et al. 2006) in which a fourth level (Primordial
Prevention) was included. Today, all four levels of prevention comprise the
Prevention Framework. In summary, these are:
Primordial Prevention This was stimulated by the recognition of upstream determinants of health and safety. It is considered that prevention could be maximally
addressed if the source of exposure could be eliminated, preventing penetration of
the risk factor into the population. Thus, the need to focus efforts on removing even
the possibility of exposure (for instance, eradicating tobacco plants and thus eliminating the source of tobacco exposure and hence the need for Primary Prevention).
Primary Prevention To reduce the risk of illness and premature death, public
health professionals use health promoting messages to motivate people to do all in
their power to avoid continued exposure to any substance/behaviour that might be
harming their health and well-being. There are two strategies that are invoked here:
the first is the Population Strategy; the second is the High-Risk Individual Strategy.
Secondary Prevention Where people have been exposed, Secondary Prevention is
invoked to screen those who have been exposed to determine if clinical and other
changes may be apparent. Early detection drives this approach because the earlier that
the medical system intervenes in the progression of illness, the more likely it will be
that a person can be spared from declines in health and reduced life expectancy.
Tertiary Prevention Where people who were exposed have become ill, Tertiary
Prevention applies to rehabilitation efforts that might restore some level of normal
function resulting in a reasonable ongoing quality of life.
It is the first two of these Levels of Prevention that are of greatest potential in the
realm of ecological declines. The latter two can be helpful in the work of those
doing cost-benefit analysis for determining costs saved through the implementation
of effective Primordial and Primary Prevention strategies.
4 The Four Ds
When competent and impartial applied health scientists studying diseases where
they arise discover a finding that does not support the status quo, going contrary to
the interests of a powerful stakeholder, the epidemiologist must be prepared to face
the “Four D’s.” These are applied with the intent of avoiding responsibility and
culpability from harms caused.
The scientist can be confronted with:
• Deny—denial that the findings could be correct
• Delay—in that more research will be called for
• Divide—in that commissioned work will result in biased findings
• Discredit—if the scientist persists, he/she will be discredited.
C. L. Soskolne
edition in 2006, that the World Health Organization (WHO) released the textbook
Basic Epidemiology (Bonita et al. 2006) in which a fourth level (Primordial
Prevention) was included. Today, all four levels of prevention comprise the
Prevention Framework. In summary, these are:
Primordial Prevention This was stimulated by the recognition of upstream determinants of health and safety. It is considered that prevention could be maximally
addressed if the source of exposure could be eliminated, preventing penetration of
the risk factor into the population. Thus, the need to focus efforts on removing even
the possibility of exposure (for instance, eradicating tobacco plants and thus eliminating the source of tobacco exposure and hence the need for Primary Prevention).
Primary Prevention To reduce the risk of illness and premature death, public
health professionals use health promoting messages to motivate people to do all in
their power to avoid continued exposure to any substance/behaviour that might be
harming their health and well-being. There are two strategies that are invoked here:
the first is the Population Strategy; the second is the High-Risk Individual Strategy.
Secondary Prevention Where people have been exposed, Secondary Prevention is
invoked to screen those who have been exposed to determine if clinical and other
changes may be apparent. Early detection drives this approach because the earlier that
the medical system intervenes in the progression of illness, the more likely it will be
that a person can be spared from declines in health and reduced life expectancy.
Tertiary Prevention Where people who were exposed have become ill, Tertiary
Prevention applies to rehabilitation efforts that might restore some level of normal
function resulting in a reasonable ongoing quality of life.
It is the first two of these Levels of Prevention that are of greatest potential in the
realm of ecological declines. The latter two can be helpful in the work of those
doing cost-benefit analysis for determining costs saved through the implementation
of effective Primordial and Primary Prevention strategies.
4 The Four Ds
When competent and impartial applied health scientists studying diseases where
they arise discover a finding that does not support the status quo, going contrary to
the interests of a powerful stakeholder, the epidemiologist must be prepared to face
the “Four D’s.” These are applied with the intent of avoiding responsibility and
culpability from harms caused.
The scientist can be confronted with:
• Deny—denial that the findings could be correct
• Delay—in that more research will be called for
• Divide—in that commissioned work will result in biased findings
• Discredit—if the scientist persists, he/she will be discredited.
C. L. Soskolne