Iceberg of Disease Iceberg of Disease Concepts of control and Concepts of control and

Levels of PreventionLevels of Prevention

Dr. Jai Kershan, MD, MSPH Dr. Jai Kershan, MD, MSPH (USA)(USA)

http://jaikershan.blogspot.comhttp://jaikershan.blogspot.com

We will learn in this presentation We will learn in this presentation Concepts of iceberg of diseaseConcepts of iceberg of disease Concepts of disease controlConcepts of disease control Concepts of prevention, likeConcepts of prevention, like

• Primary, secondary & tertiary preventionPrimary, secondary & tertiary prevention

Iceberg of DiseaseIceberg of Disease

continuecontinue The floating tip of ice berg represents The floating tip of ice berg represents

clinical casesclinical cases Submerge portion shows Submerge portion shows

undiagnosed cases or hidden mass of undiagnosed cases or hidden mass of diseasedisease

Undiagnosed reservoir of disease is a Undiagnosed reservoir of disease is a challenge to modern techniques in challenge to modern techniques in preventive medicinepreventive medicine

Disease controlDisease control Aimed at reducingAimed at reducing

• Incidence of diseaseIncidence of disease• Duration of diseaseDuration of disease• Physical and psychological complicationsPhysical and psychological complications• Reducing financial burden of communityReducing financial burden of community

Activities consist of primary Activities consist of primary preventionprevention

Can be secondary preventionCan be secondary prevention

Primordial preventionPrimordial prevention This is special in the sense of This is special in the sense of

preventing chronic diseases like preventing chronic diseases like • obesity and hypertensionobesity and hypertension

Prevention of risk factors in Prevention of risk factors in population which have yet not population which have yet not appearedappeared

Smoking, eating patterns, exerciseSmoking, eating patterns, exercise Main intervention is mass educationMain intervention is mass education

Primary preventionPrimary prevention Defined as action taken prior to Defined as action taken prior to

onset of diseaseonset of disease Intervention in prepathogensis of Intervention in prepathogensis of

diseasedisease WHO recommended two approachesWHO recommended two approaches Population strategyPopulation strategy High risk strategyHigh risk strategy

Population strategyPopulation strategy Directed at whole populationDirected at whole population Education of exerciseEducation of exercise Lowers serum cholesterolLowers serum cholesterol Lowers risk of cardiovascular diseasesLowers risk of cardiovascular diseases High risk strategyHigh risk strategy Preventive care to people at special riskPreventive care to people at special risk Safety and lower cost justifies its wider Safety and lower cost justifies its wider

applicationapplication

Secondary preventionSecondary prevention Action taken at incipient stage of Action taken at incipient stage of

diseasedisease Specific interventions are Specific interventions are

• ScreeningScreening• Case finding programsCase finding programs• more expensive and less effective than more expensive and less effective than

primary preventionprimary prevention Draw back is patient feels pain & Draw back is patient feels pain &

productivityproductivity

Tertiary preventionTertiary prevention

When disease is advanced beyond its When disease is advanced beyond its early stagesearly stages• All measures available to reduce pain All measures available to reduce pain

and diseasesand diseases• When disability stabilized then apply When disability stabilized then apply

rehabilitationrehabilitation• Consist of psychosocial, vocational and Consist of psychosocial, vocational and

medical componentsmedical components