2. Primary prevention
What is it?
Taking action to reduce the incidence of disease and health problems within the population, either through universal measures that reduce lifestyle risks or by targeting high-risk groups.
Why is it important?
- Effective primary prevention helps patients to avoid health problems before they occur. While prevention in childhood provides the greatest benefits, it is valuable at any point in life.
- It is estimated that 80 per cent of cases of heart disease, stroke and type 2 diabetes, and 40 per cent of cases of cancer could be avoided if common lifestyle risk factors were eliminated (WHO 2005).
- Primary prevention is an excellent use of resources when compared with many treatment and curative interventions. Of more than 250 studies on prevention published in 2008, almost half showed a cost of under £6,400 per quality-adjusted life year (QALY) and almost 80 per cent cost less than £30,000 per QALY, the cut-off used by the National Institute for Health and Clinical Excellence (NICE) for cost-effectiveness (van Gils et al 2010).
- The financial sustainability of the NHS in the future will depend on more systematic primary prevention in order to reduce the overall burden of disease in the population.
What is the impact?
More systematic primary prevention in general practice has the potential to improve health outcomes and save costs in many areas of primary care (Health England 2009), for example:
- five minutes of advice in general practice to middle-aged smokers to quit smoking can increase quit rates and save £30 per person for a cost of £11 per person
- brief interventions in general practice to reduce problem drinking can reduce alcohol consumption by 40 per cent over 12 months with overall cost savings outweighing intervention costs
- brief intervention in general practice to improve exercise uptake can increase the chances of adults undertaking moderate activity by over 20 per cent and vigorous activity by 6 per cent with cost savings of £3,300 per person.
How to do it
Guidance on how to achieve good results from primary prevention through primary care and through working with other local agencies is available to commissioners from NICE, public health departments, Health England and the National Support Teams for tobacco, alcohol, infant mortality and inequalities.
Evidence-based interventions range from:
- brief advice to individuals to quit smoking during an opportunistic consultation (even simply raising the issue)
to:
- systematic, planned community interventions in schools to reduce childhood obesity.
NHS Knowsley has had a major impact on smoking rates in disadvantaged communities through cross-partnership action including targeting illicit tobacco sales, reducing smoking in pregnancy, and providing drop-in clinics in disadvantaged areas. These approaches often require new ways of engaging with communities to ensure they reach those in greatest need.
Useful resources
- NICE's public health guidance including on primary prevention.
- Health England has developed several useful reports on the impact and cost-effectiveness of primary prevention and modelling tools to help local areas prioritise.
- Relevant National Support Teams, including those focussing on tobacco, alcohol, infant mortality and inequalities, have information on their systematic approach to primary prevention, modelling and case studies.
For more information
- Download all ten priorities: Transforming our health care system
- You can also find all the references mentioned here in that version
- Listen to Candace Imison talk through the ten priorites in our audio slideshow
