Overview
This chapter covers the natural history of disease, the four levels of prevention, public health functions, strategies for health promotion, and the Ottawa Charter, linking them to physician roles and exam objectives.
Natural History of Disease and Prevention
- The natural history of disease describes its course without treatment, helping to identify intervention opportunities.
- Prevention ideally happens before disease onset and targets the whole population or high-risk groups.
- The "iceberg" metaphor highlights many undetected or at-risk cases in the community.
Stages of Prevention: Primordial, Primary, Secondary, Tertiary
- Primordial prevention targets population-level health determinants to prevent risk factor development (e.g., healthy policies, improved sanitation).
- Primary prevention reduces disease incidence by addressing risk factors before disease begins (e.g., vaccination, smoking cessation).
- Secondary prevention detects and treats early disease to prevent progression (e.g., screening, early intervention).
- Tertiary prevention aims to reduce impact and complications of established disease, focusing on quality of life and rehabilitation.
Health Protection and Health Promotion
- Health protection involves regulatory and environmental measures to prevent exposure to hazards (e.g., sanitation, food and water safety).
- Surveillance systems help identify and control risks at population level.
- Health promotion empowers individuals and communities to improve health, extends beyond education, and creates supportive environments.
Strategies for Community Needs Assessment
- Community health promotion involves assessing local priorities, engaging stakeholders, and matching interventions to identified needs.
- Community engagement and support increase the relevance and uptake of health programs.
Ottawa Charter for Health Promotion
- Five strategies: building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services.
- Seven prerequisites for health: peace, shelter, education, food, income, stable ecosystem, and sustainable resources.
Physician Roles in Health Promotion and Disease Prevention
- Physicians can advocate, educate, and participate in programs such as immunization, screening, and lifestyle counseling at individual and community levels.
Key Terms & Definitions
- Natural history of disease — The course of a disease in an individual without medical intervention.
- Primordial prevention — Actions to prevent the emergence of risk factors.
- Primary prevention — Efforts to prevent disease onset by reducing risk.
- Secondary prevention — Early detection and treatment to halt disease progression.
- Tertiary prevention — Reducing harm and improving quality of life after disease onset.
- Health promotion — Processes to enable individuals/communities to increase control over their health.
- Health protection — Legal, regulatory, and environmental measures to safeguard health.
Action Items / Next Steps
- Review Medical Council exam objectives, Section 78-3.
- Reflect on practical examples of Ottawa Charter strategies in local family medicine settings.
- Prepare for self-test questions at the end of the chapter.