When it comes to health, one of the most commonly used and often also most misunderstood terms is “prevention.” A word we hear often in health care, in the media, and in public campaigns, but it is not always clear what it really means, how it is applied, and especially how broad and articulate it is.
Knowing the meaning and practices of prevention also means understanding how we can take care of our health more consciously and how the health care system, together with institutions and society, contributes to this goal, which does not have to weigh all on the shoulders of the individual person.
What does it really mean to prevent
In health care, prevention refers to a set of actions and strategies that aim to reduce the risk of disease occurrence, intercept them early or limit their consequences. Thus, it is a dynamic concept that accompanies people throughout the course of their lives and is divided into different types.
Three levels of prevention are generally distinguished in medicine:
Primary prevention
It is the one that intervenes before the disease manifests itself. The goal is to prevent the disease from developing, through all those actions that reduce the risk factors (conditions, behaviors or characteristics that increase the likelihood of developing a disease) and promote healthy behaviors, such as:
- vaccinations
- balanced nutrition
- regular physical activity
- Abolition of smoking and reduction of alcohol
- Use of protective equipment in hazardous work settings
At this stage, the role of the individual is central, because many daily choices directly affect the possibility of maintaining one’s health. However, this is never an exclusively personal responsibility: health care facilities and institutions play a decisive role in making these behaviors possible and accessible, while the social context in which the person lives can make it easier or more difficult to maintain healthy lifestyles.
Secondary prevention
It is based on theearly detection of a disease, often before obvious symptoms appear. The goal is to diagnose early in order to intervene more effectively and less invasively.
Typical examples are:
- Cancer screening (mammography, pap smear, fecal occult blood test)
- Periodic blood pressure or blood glucose checks
- Monitoring diagnostic tests in at-risk individuals.
In this case, the health system takes on a particularly relevant role, because it is through the organization of screening programs and the activity of diagnostic facilities that it becomes possible to intercept diseases early on a large scale. Citizens are called upon to actively participate by adhering to screening pathways, while general practitioners are often the first point of reference for identifying at-risk individuals and directing them to the most appropriate examinations. Finally, institutions must ensure that these programs are equitably accessible to the entire population and that they can be carried out on a stable and continuous basis.
Tertiary prevention
Intervenes when the disease is already present and aims to limit its complications, reduce disability and improve the patient’s quality of life.
They fall into this category:
- rehabilitation paths
- clinical follow-ups
- chronicity management
- psychological and social support
At this stage, the role of health facilities becomes central, because it is through the multidisciplinary intake of the person that continuous and personalized care pathways are built. Hospitals and health professionals work together to ensure not only treatment of the disease, but also functional recovery and maintenance of the best possible quality of life. The patient, for his or her part, remains an active part of the treatment process through adherence to treatment and follow-ups, while institutions are responsible for ensuring integrated and accessible services capable of accompanying the person throughout the entire care pathway without interruption.
Another distinction widely used today is that between universal and selective prevention, especially in areas such as public health and addiction or chronic disease prevention. The universal prevention is aimed at the entire population, regardless of risk. A typical example is vaccination campaigns or initiatives to promote healthy lifestyles. The idea is to act broadly, seeking to reduce the incidence of disease collectively. The selective prevention, on the other hand, more specifically targets population groups that have a higher than average risk due to family, environmental, social or work factors. Typical examples are awareness campaigns against tobacco smoking or cardiovascular prevention programs for individuals with a family history of premature heart attack, hypertension or diabetes.
Alongside these classifications, in some contexts we also speak of quaternary prevention, a relatively newer concept. In this case, the goal is not so much to prevent a disease as to Avoid the risk of overdiagnosis, overtreatment, or unnecessary health interventions. In other words, it seeks to protect the patient from overmedicalization by promoting the appropriate and proportionate use of health care resources.
Prevention, health promotion and health education: not the same thing
Often these three concepts are used synonymously, but in reality they have distinct, though closely related, meanings.
Health promotion
Health promotion is a broader concept than prevention. It focuses not only on disease, but on the overall well-being of the person and the community. According to this view, health is not simply the absence of disease, but a condition of physical, mental and social balance. Health promotion therefore includes public policies oriented toward well-being in a broad sense (urban planning, employment, schools), creation of environments conducive to health, reduction of social inequalities, empowerment of people in everyday choices.
It not only concerns the health sector, but also involves schools, local governments, the world of labor and civil society.
Health education
Health education, on the other hand, is the tool through which knowledge, skills and awareness are provided to people, so that they can adopt healthier behaviors. It is, so to speak, the cultural basis on which both prevention and health promotion are built. It can take place through information campaigns, school programs, individual consultations (e.g. with doctors and nurses).
If health promotion acts on the context, education acts primarily on the person.
Who are the actors in prevention and health promotion
One of the most important aspects to understand is that nne of these processes works in isolation. Health prevention, promotion and education are the result of a complex network of actors.
Hospitals, health districts, general practitioners, specialists and health professionals play a central role. They are the ones to:
- Deliver screening and monitoring
- Early detection of pathologies
- Accompany patients on the pathways of care and prevention
- Doing health education during visits and hospitalizations
Facilities such as hospitals not only deal with the acute phase of the disease, but increasingly also with prevention and continuity of care.
Regions, municipalities, the Ministry of Health and the National Health Service. Have a planning and steering role. They are responsible for:
- organizing screening programs
- fund prevention campaigns
- define guidelines and protocols
- Creating health-oriented public policies
Without a strong institutional level, prevention cannot be systematic and accessible to the entire population.
Last but not least, there is the person. Citizens are not passive subjects, but active participants in their own health journey. Everyday decisions (such as diet, level of physical activity, quality of sleep, attention to the use of substances such as smoking and alcohol) have a concrete impact over time. Added to this is another key aspect: the ability to Recognize the signals of one’s body and not to postpone checks or in-depth investigations when you notice a discomfort or change that persists over time or is unusual compared to your usual condition. In these cases, rather than worrying, it is useful to consult with one’s referring physician, who can help to assess the situation properly and direct any further investigation.
Prevention as a collective project
The difficulties in implementing proper prevention are many and, in fact, rarely depend on a single factor. More often they arise from the intertwining of individual, organizational, cultural and social elements. It is precisely this complexity that explains why, despite the fact that prevention is recognized as one of the most effective tools of modern medicine, it does not always succeed in expressing its full potential in daily practice.
A first difficulty concerns People’s perception of risk. Prevention, especially primary and secondary prevention, often acts in the absence of symptoms. This can lead to underestimating the importance of check-ups or screenings, because we tend to give more weight to what is urgent and perceived (a disease already occurring) than to what has not yet manifested. This results in attitudes of procrastination and procrastination, poor adherence to screening programs, or difficulty in permanently changing unhealthy lifestyles.
A second critical element concerns health education and the level of awareness. Not all people have the same information or tools to understand the meaning of medical recommendations and to translate them into concrete behaviors. In this sense the Cultural and educational inequalities play an important role, because they influence the ability to navigate health choices.
Alongside this is the issue of socioeconomic inequalities. Prevention is not always equally accessible: economic hardship, poor working conditions, time constraints or problems accessing health services can be real obstacles.
Another difficulty concerns the health care system itself and its ability to integrate. Prevention works well when it is continuous, coordinated and easily accessible. However, fragmentation of services, overloaded facilities or difficulties in communication between the territory and the hospital can reduce the effectiveness of preventive pathways, making them less fluid or less capillary.
Finally, the following should not be overlooked the weight of cultural and behavioral factors. Some lifestyle habits are deeply ingrained in our daily lives, and changing them requires time, motivation and constant support. Even with the right information, changing eating styles, increasing physical activity or giving up smoking is not easy because psychological, social and relational aspects come into play.
For all these reasons effective prevention cannot be entrusted to a single actor, but requires a coordinated network and shared responsibility among citizens, health professionals and institutions.
The role of private contracted health care
The private contracted hospitals play an important role within the health care system because they help to make the provision of services more widespread and accessible, while remaining within the framework of the National Health Service.
Participate often in the provision of services related to the secondary prevention, such as specialist visits, diagnostic tests and screening activities provided by regional programs. In this way they help reduce waiting times and ensure that more people can access screening in a timely manner. Their contribution is also significant in the management of pathologies already present, especially through follow-up, rehabilitation and continuity of care pathways, which are part of the tertiary prevention. Often this work is done in collaboration with public hospitals and general practitioners, within a network that follows the patient over time.
The fact that they operate under an agreement also means that these facilities must adhere to rules, standards and pathways defined by the public health system, thus ensuring uniformity and quality of services.
In this sense, contracted clinics should not be seen as a separate system, but an integrated part of the health care network: they contribute to making it more efficient and closer to people’s needs, especially with regard to diagnostics and continuity of care.
