The false dichotomy between prevention and tratment and why it needs to be addressed

Paul Batchelor

Abstrakt

The last decade has seen a substantial growth in health policies stressing the need for “prevention orientated” solutions over treatment provision as an approach to addressing health needs. Such an approach infers that there is a clear distinction between the two approaches and that a shift of resources from current care modalities, with their emphasis on addressing health needs through treatment orientated health services, to approaches that adopt interventions aimed at addressing problems before they arise, will provide better outcomes, not least in terms of use of resources. This paper argues that such an approach is too simplistic and fails to take account of the changing nature of health conditions affecting populations.

 

The major changes in the epidemiology of health conditions have seen a shift in emphasis away from acute to chronic disease problems. This alteration in the pattern of health conditions means that a key feature of health services is their re-orientation from eradication of illness to its management. The dichotomy between prevention and treatment of a particular condition is both inappropriate, indeed damaging in the debate on how to address health needs. Using examples from a number of elements of the health sector, the paper argues that there is a need to move away from interventions using a empirical base centering on prevention or treatment to one that adopts the idea of managing health conditions, the goal of which is the aim of reducing the impacts of the problem on individuals. Such an approach would allow a more constructive dialogue between all sectors involved in improving the health of society, not least ensuring that the economical aspects of policy making have a more sound base.

Słowa kluczowe: potrzeby zdrowotne, polityka zdrowotna, prewencja
References

WHO, Prevention is better than cure, say Romanian doctors, “Bulletin of the World Health Organization” 2011; 89: 248–249.

Davies A., Prevention is better than cure, The Nuffield Trust, http://www.nuffieldtrust.org.uk/blog/prevention-better-cure; accessed: 02.2015.

Cookson R., Bean counting and the NHS, http://aheblog.com/2014/07/14/bean-counting-and-the-nhs/; accessed: 02.2015.

Omran A.R., The epidemiologic transition: theory of the epidemiology of population change, “Milbank Memorial Fund Quarterly” 1971; 29: 509–538.

Zuckerman M.K., Harper K.N., Barrett R., Armelagos G.J., The evolution of disease: anthropological perspectives on epidemiologic transitions, “Glob Health Action” 2014; 7: 23303.

Rose G., Sick individuals and sick populations, “International Journal of Epidemiology” 1985; 14: 32–38 [Reprinted in “International Journal of Epidemiology” 2001; 30: 427–432].

Batchelor P., Sheiham A., The limitations of ‘high-risk’ approach for the prevention of dental caries, “Community Dentistry and Oral Epidemiology” 2002; 30: 302–312.

McClaren L., McIntyre L., Kirkpatrick S., Rose’s population strategy of prevention need not increase social 
inequalities in health
, “International Journal of Epidemiology” 2010; 39: 372–377.

Zulman D.M., Vijan S., Omenn G.S., Hayward R.A., The relative merits of population-based and targeted prevention strategies, “The Milbank Quarterly” 2008; 86: 557–580.

Ahern J., Jones M.R., Bakshis E., Galea S., Revisiting Rose: Comparing the benefits and costs of population-wide and targeted interventions, “The Milbank Quarterly” 2008; 86: 581–600.

Kuh D., Ben-Shlomo Y., Lynch J., Hallqvist J., Power C., Life course epidemiology, “Journal of Epidemiology and Community Health” 2003; 57:.778–783.

Ebrahim S., Taylor F.C., Brindle P., Statins for the primary prevention of cardiovascular disease, “BMJ” 2014: 348: g280.

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