The most important primary heath prevention intervention is sanitation. The provision of uncontaminated water and food supplies to the population is the most cost effective primary public health prevention strategy available to any population. Teaching individuals to wash their hands, dispose of their wastes hygienically and prepare food (and potable water) hygienically saves more lives than any other educational measure at the cost of initially creating a population explosion in societies where this has not occurred before.
Medications have a limited role in primary prevention as life style interventions are likely to be more cost effective. However medical screening for asymptomatic conditions such as hypertension and hypercholestaemia can lead to cost effective drug intervention.
Adding statins for primary prevention of ischaemic heart disease greatly increases the difficulty and expense and reduces the certainty of benefit for the individual compared to their use in secondary prevention.
Immunisation and fluoridation of water are primary prevention exercises aimed at the entire population. The suggested PolyPill would be one aimed at all adults over, say, 50 but in practice is likely to be targeted.
Effective primary prevention of illness is likely to be a task for society rather than one that can be left to the medical services. This leads to difficulties because politics and politicians often have subjective influences. For example intervening against smoking threatened those already addicted and major financial and employment interests who benefited by peddling an addictive product. Providing the birth control necessary to prevent population overgrowth can destabilize social structures and threaten political and religious power.
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