Primary Prevention in the 21st Century

by

Martin Bloom

• LAST REVIEWED: 27 June 2017
• LAST MODIFIED: 27 June 2017
• DOI: 10.1093/obo/9780195389678-0251

Introduction

The 19th century saw the beginnings of prevention, focused primarily on specific issues, like Dr. John Snow’s (b. 1813–d. 1858) intuitive epidemiology that led to the prevention of a mysterious disease (cholera) by removing the water pump handle (of a contaminated public water source); or Pasteur’s (b. 1822–d. 1895) solid research leading to the pasteurization of milk (thus preventing illness from contaminated milk, among his many achievements). The 20th century expanded this vision through the work of large numbers of workers all over the world, and eventually came to include the prevention of predictable untoward events, the protection of existing states of health and healthy functioning, and the promotion of desired events for populations of individuals or groups relative to given physical environments and sociocultural settings. As illustrated here, many professional and nonprofessional people involved in topics on health and well-being in the 21st century are beginning to see these issues in more complex terms: to see more systemic interrelationships among helping modalities—prevention, protection, promotion, treatment, rehabilitation, and palliative care—and more cooperative ventures among social agencies, governments, universities and citizens’ groups. Tadmor (2014) in the chapter “Cancer: Multiple Services for Children Dying of Cancer and for Their Families” (in Gullotta and Bloom 2014, cited under Theories Used in Primary Prevention), Ciporah S. Tadmor illustrates why it is no longer possible to provide palliative care solely to a dying teenager without considering related health issues that might arise within his or her family, which may also need help in reconstituting (rehabilitating) the family without its lost member, all of which involve protecting existing healthy functioning of members, promotion of desired goals (to help move the family members forward in their lives), and prevention of any predictable issues that might interfere with their functioning.

History of Primary Prevention

Events were seen by prehistoric humankind as caused by gods (good things) or devils (bad things), with the actual causes discovered thousands of years later, although we still have many diseases yet to be conquered. Careful bedside observation by Hippocrates led to the idea of knowable causes of problems in the physical environment, even though specific causes of these problems may have been incorrect (miasma or swamp gases as cause of malaria, so drain the swamps—and be rid of mosquitos as a by-product). (The led to the sanitation movement, also before the actual causes of disease were identified.) As Rosen 1958 comments, private disgust at filth and waste was turning into a public concern. Today’s health promotion involves a range of activities that cut across levels of analysis, and that involve the community, culture, and the environment as health challenges become recognized as increasingly complex. Groups of people were always concerned with survival, at minimum, after which they could consider how their society might flourish. Cultural values as well as social structures evolved to provide for the cohesion and safety of their people. Much of the time, these cultural arrangements worked perfectly well; other times they led to a destructive myopia, as when some Christians massacred medieval Jews during a plague in Strasbourg because the Jews had a lower death rate and were suspected of poisoning their neighbors’ wells. In fact, the Jews had ritually cleaned their houses as directed by their religion, leaving little pickings for rats, who turned their plague-carrying attention elsewhere in the city. Other times, societies tried to prescribe many details of social life of people—such as Johann Peter Frank (b. 1745–d. 1821), who tried to set up a medical police in early-19th-century Austria-Hungary to control every aspect of social life—“all for their own good”—only to find these people opposing public health regulations in favor of independent choices. These cultural issues are with us today, such as opposition to required vaccinations of public school children. Fortunately, culprits began to become known, from Antonie van Leeuwenhoek’s (b. 1632–d. 1723) “little beasties” wiggling around in his primitive two inch microscope, to the germ theory that Robert Koch (b. 1843–d. 1910) forced the world to recognize through his demonstrating his own causal postulates. The golden age of bacteriology showed that many diseases were caused by bacteria (but not all), and that we have to pay attention to the invisible world around (and in) us. The downside of the great triumph of germ theory and bacteriology is that the little beasties do not operate in a vacuum, and, indeed, humans are hosts for innumerable bacteria and yeasts that are positively helpful, even necessary, to survival.

• Bloom, M. 1981. Primary prevention: The possible science. Englewood Cliffs, NJ: Prentice-Hall.

  This book is one of the early efforts devoted exclusively to primary prevention (hereafter PP). It contains definitions of PP, historical background, exemplars, strategies in the practice of PP, evaluation of PP programs, and a discussion of barriers to, and criticisms of PP.

• Repetto, P. B., M. Bernales, and B. Cabieses. 2014. History of primary prevention and health promotion. In Encyclopedia of primary prevention and health promotion. 2d ed. Edited by T. P. Gullotta and M. Bloom, 13–31. New York: Springer.

  Repetto and colleagues use the phrase “new public health,” reflecting the recent emphasis in promotion as a major component of primary prevention. They describe the recent evolution of health promotion technologies to gather, store, analyze, and transmit information to users, which often involves changes in lifestyle within the sociocultural context of clients’ lives.

• Rosen, G. 1958. A history of public health. New York: MD.

  DOI: 10.1037/11322-000

  This is one of the great histories of public health, from ancient times to the mid-20th century. It is, as well, a history of humankind, and a very dramatic history at that. Readers might also want to explore Rosen’s other scholarly books: From Medical Police to Social Medicine: Essays on the History of Health Care (New York: Science History Publications, 1974); and Preventive Medicine in the United States, 1900 to 1975: Trends and Interpretations (New York: Science History Publications, 1975).