The Concept of Prevention

Because arthritis imposes a tremendous individual and societal burden—and because effective interventions are available—arthritis needs a coordinated public health approach. The focus of that approach should be broad and encompass whole population groups—in contrast with the classical medical approach, which addresses the individual patient.

Although, at present, arthritis is not entirely preventable, research is being conducted to identify the risk factors and causes of the various forms of arthritis so that one day arthritis may be prevented. The challenge for public health is to identify and implement effective strategies for improving the health of an entire population. Key to the public health model for arthritis is the concept of prevention. According to the National Arthritis Action Plan (NAAP), this concept encompasses three levels:

1. Primary prevention is designed to prevent a disease or condition (such as arthritis), from occurring in the first place.
   
   
Examples:
• Regular physical activity to reduce the risk of developing cardiovascular disease and vaccination against infectious diseases are classic examples of primary prevention measures.
• An example of a primary prevention for arthritis is protecting a joint from repetitive stresses which can lead to osteoarthritis.
2. Secondary prevention attempts to identify a disease at its earliest stage so that prompt and appropriate management can be initiated. Successful secondary prevention reduces the impact of the disease.


Examples:
• A person gets a mammogram to detect breast cancer or gets screened for glaucoma.
• A person with joint symptoms sees their doctor and is diagnosed with arthritis, allowing treatment to begin at an early stage of the disease.
3. Tertiary prevention focuses on reducing or minimizing the consequences of a disease once it has developed. The goal of tertiary prevention is to eliminate, or at least delay, the onset of complications and disability due to the disease. Most medical interventions fall into this category.


Examples
• A person with diabetes keeps their blood glucose under tight control to prevent diabetic complications.
• A person with arthritis takes the Arthritis Foundation Self-Help Program to learn skills to help manage their arthritis.

Importance of population-based strategies—While clinical care usually addresses the needs of an individual person, public health addresses the needs of select population groups. Population-based interventions are designed to reach out to most members of a defined population, not just those who appear for medical treatment, or turn up for a community event. Primary, secondary, and tertiary prevention can all be delivered at the population level.