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“P” is for prevention. Is the cluster fully capitalising on preventive opportunities?

What is prevention?

  • Zola's river analogy is a useful way of thinking about prevention of ill health (Zola 1970). It describes primary prevention (stopping everyone from falling into a river and coming to harm e.g. never smoking), secondary prevention (ensuring any individuals at risk who do fall in get to safety quickly; minimising the chance of complications through early identification and intervention e.g. screening) and tertiary prevention (search-and-rescue for those taken downstream; mitigating the worst consequences of established disease e.g. vascular surgery).
  • The Welsh Government definition of prevention is broader: working in partnership to co-produce the best outcomes possible, utilising the strengths and assets people and places have to contribute.

 What is the primary care role in prevention?

  • The Well-being of Future Generations (Wales) Act 2015 enshrines the primacy of prevention in law.
  • Public health intelligence suggests that the majority of the avoidable burden of disease in Wales can be attributed to four key clinical risk factors (high blood pressure; high body mass index; high cholesterol; and high fasting glucose) and four key behavioural risk factors (smoking; poor diet; physical inactivity; and substance use).
  • Primary care clinicians play critical roles in identifying and managing clinical risk factors (e.g. hypertension), as well as encouraging the primary and secondary prevention of behaviourally-modifiable risk factors (e.g. smoking).
  • Risk reduction interventions mediated by clinicians at the individual level complement risk reduction strategies undertaken at the population level; both approaches are critical to overall population health improvement and to the reduction of many health inequalities that result from diseases consequential from these factors.
  • A healthcare system that actively prevents avoidable morbidity (illness) and mortality (death) is more sustainable than one that throws effort and money after the horse that has bolted.

How can clusters/ pan-cluster planning groups emphasize prevention?

Building a healthier Wales (Feb 2019) sets out six key principles for implementing prevention in Wales:

  • Adhere to the five ways of working (as outlined in the Well-being of Future Generation Act).
  • Commit to investing in evidence-based interventions (where available or evaluate small and scale up if appropriate).
  • Ensure evidence-based interventions have sufficient scale and reach to make a measurable population impact and to reduce inequalities.
  • Ensure services are provided to a sufficient quality to achieve the best possible outcomes for each intervention; continually improve by drawing upon quality improvement techniques.
  • Balance intervention benefits for short and long-term outcomes (including investing in one sector to realise a return in another).
  • Optimise value by taking an agile approach to evaluating interventions and approaches and disinvesting in those that do not yield benefit/ value.

See also Population health information by topic, which emphasises the primacy of prevention and takes a topic/ condition-based approach to considering population needs