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 and their causes or by targeting high-risk groups.

Why is it important?

  • More systematic primary prevention is critical in order to reduce the overall burden of disease in the population and maintain the financial sustainability of the NHS. 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 factoes were eliminated (WHO 2005).
  • Common lifestyle risk factors cluster in the population (Buck and Frosini 2012), which has a dramatic effect on life expectancy (Khaw et al 2008). Addressing this clustering, and its socio-economic determinants, is likely to reduce inequalities and improve overall population health.

    What is the impact?

    • Primary prevention is an excellent use of resources compared with many treatments. Of more than 250 studies on prevention published in 2008, almost half showed a cost of under £6,400 per quality-adjusted life year and almost 80 per cent cost less than the £30,000 threshold used by the National Institute for Health and Clinical Excellence for cost-effectiveness (van Gils et al 2010).
    • More systematic primary prevention in general practice has the potential to improve health outcomes and save costs (Health England 2009). For example, five minutes of advice in a general practice setting to middle-aged smokers to quit smoking can increase quit rates and save £30 per person for a cost of £11 per person.
    • Community-level campaigns to improve health behaviours, such as No Smoking Days, have been found to be very cost-effective (£82 per life year gained) (Kotz et al 2010).

    How to do it

    Evidence-based interventions include: supporting individuals to change behaviours, for example, through brief advice during a consultation; systematic community interventions in schools to reduce childhood obesity; and regulatory actions such as controlling the density of alcohol outlets (Campbell et al 2009).

    In many areas, a strategic approach using a combination of interventions at the individual and societal level is likely to be most effective. For example, NHS Knowsley has had a major impact on smoking rates in disadvantaged communities through cross-partnership action including targeting illicit toboacco sales, reducing smoking in pregnancy, and providing drop-in clinics.

    These approaches often require new ways of engaging with communities to ensure they reach those in greatest need. Social marketing techniques can improve the effectiveness of interventions by tailoring interventions to the needs of specific individuals or groups.

    NHS England, acting in its new role as the single purchaser of NHS primary care, has an important opportunity to ensure that primary prevention is implemented systematically and at scale.

    Useful resources

    For more information