The Syllabus Says |
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Discuss the geographic factors that determine the relative emphasis placed by policy-makers, in one country or region, on prevention as opposed to treatment of disease.
Prevention is better than the cure? Prevention versus treatment
There are two main approaches to improving the health of a population:
Since the advent of modern medicine, most health systems have followed a curative approach. However, over the last few decades there has been an increasing awareness of the benefits of a primary healthcare approach. The video on the right briefly outlines the benefits of this approach. |
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Strategies towards primary healthcare
The World Health Organisation states that the ways to achieve the aims of primary healthcare are as follows:
1. Reducing exclusion and social disparities in health (universal coverage reforms);
2. Organising health services around people's needs and expectations (service delivery reforms);
3. Integrating health into all sectors (public policy reforms);
4. Pursuing collaborative models of policy dialogue (leadership reforms); and
5. Increasing stakeholder participation
General factors affecting primary healthcare
There are many limiting factors that prevent primary healthcare from being universally achievable, at least in the immediate future:
The World Health Organisation states that the ways to achieve the aims of primary healthcare are as follows:
1. Reducing exclusion and social disparities in health (universal coverage reforms);
2. Organising health services around people's needs and expectations (service delivery reforms);
3. Integrating health into all sectors (public policy reforms);
4. Pursuing collaborative models of policy dialogue (leadership reforms); and
5. Increasing stakeholder participation
General factors affecting primary healthcare
There are many limiting factors that prevent primary healthcare from being universally achievable, at least in the immediate future:
- Access to medical care varies due to the availability of health professionals, including the quality as well as quantity
- Access to medication
- Ability to pay (both at the national and individual levels)
- Safe water supply and sanitation are of key importance
- Health education traditionally ignored (e.g. value of breast feeding infants)
Geographic factors affecting healthcare
The table below shows the factors that would affect the decision of applying preventative (primary) versus curative healthcare. It is the balance of these factors, rather than any specific 'pro or con' that will decide the final approach.
Source: Stephen Coddrington's Planet Geography (6th ed.)
Prevention is better than the cure
There is a humanitarian argument in favour of primary healthcare rather than curative. 75% of healthcare spending in the United States is for preventable illnesses such as Type 2 diabetes and heart disease. People who are receiving treatment would likely wish to avoid having the disease in the first place.
In addition, some prevention programmes are undoubtedly cost-effective. For example, the MMR (measles, mumps and rubella) vaccine significantly reduced the incidence of the diseases amongst children, for a relatively low cost (US$62.79 for ten doses, not including the cost of the medical practitioner to administer the vaccine). The cost of treating an outbreak of the disease can be much higher. In 2011, the cost of 107 cases spread across 16 outbreaks in the USA cost local and state health departments an estimated US$2.7 million to US$5.3 million (Forbes magazine, 2015). This is partly because they also tried to contain the outbreaks and so factored in the costs of isolation wards and so on, but the point is clear: disease costs money.
Prevention can also be used to justify a redution in the impact of non-communicable disease. Of the 58 million deaths worldwide in 2005, the WHO reckoned that approximately 35 million were caused by non-communicable diseases (HK Department of Health) such as lung cancer. Changing peoples' lifestyles has a long term and economically neutral impact on health.
In addition, some prevention programmes are undoubtedly cost-effective. For example, the MMR (measles, mumps and rubella) vaccine significantly reduced the incidence of the diseases amongst children, for a relatively low cost (US$62.79 for ten doses, not including the cost of the medical practitioner to administer the vaccine). The cost of treating an outbreak of the disease can be much higher. In 2011, the cost of 107 cases spread across 16 outbreaks in the USA cost local and state health departments an estimated US$2.7 million to US$5.3 million (Forbes magazine, 2015). This is partly because they also tried to contain the outbreaks and so factored in the costs of isolation wards and so on, but the point is clear: disease costs money.
Prevention can also be used to justify a redution in the impact of non-communicable disease. Of the 58 million deaths worldwide in 2005, the WHO reckoned that approximately 35 million were caused by non-communicable diseases (HK Department of Health) such as lung cancer. Changing peoples' lifestyles has a long term and economically neutral impact on health.
Cure is better than prevention
Ultimately in almost every case, primary care that prevents disease and disability would be considered more beneficial. However, there are several factors that would interfere with this general approach and promote a curative programme instead. Some general factors include:
A more detailed example of the USA shows that prevention in HICs may be ineffective for most diseases. Some ideas include:
However, these examples ultimately bring the question of prevention versus treatment down to economics and ignore the human suffering. The debate over the extent to which money and healthcare (especially the treatment of fatal illnesses) are linked and whether they should be linked at all is well debated by the Freakonomics podcast here and here.
Further details about prevention versus treatment for HIV and malaria can be found on their pages on this site.
- A new disease that was unknown before it took hold in the population, and therefore could not be prevented (such as HIV in Sub-Saharan Africa in the 1980s)
- An endemic disease, such as malaria, where it exists in such large numbers of people that it would be not be possible to use a primary care approach without at least having a curative approach alongside
- Remote areas are hard to reach and therefore have low priority until a disease occurs; therefore primary care is not provided in advance, but curative care is required after the disease occurs
- A large or uneducated population where it is hard to promote messages of disease prevention
- Lack of knowledge about how a disease is spread
- A very fast paced disease such as ebola which quickly runs through a population
- An unexpected shift in the geographical location of disease, for which the authorities are unprepared and therefore must cure rather than prevent
A more detailed example of the USA shows that prevention in HICs may be ineffective for most diseases. Some ideas include:
- Annual checks for a third of adults in the USA cost around US$8bn per year and yet do not have much impact on long term health. It would be better to spend that money on treating the more serious conditions that affect few people.
- Preventative medicine can use the time of medial professionals that reduces the time to treat conditions. For instance, 217 high-risk smokers would have to undergo a CT lung scan for one to be spared death from lung cancer.
However, these examples ultimately bring the question of prevention versus treatment down to economics and ignore the human suffering. The debate over the extent to which money and healthcare (especially the treatment of fatal illnesses) are linked and whether they should be linked at all is well debated by the Freakonomics podcast here and here.
Further details about prevention versus treatment for HIV and malaria can be found on their pages on this site.