The case for prevention is supported by all major professional organisations and is strongly embedded into the Welsh legislative and policy framework. All stress the importance of both preventing disease occurring in the first place and of intervention as early as possible to prevent its escalation.link) highlighted the need for a shift towards greater prevention and early intervention. In response, the national Strategic Programme for Primary Care includes a workstream to help ensure this focus is maintained as primary care is transformed towards a whole-system model for health and well-being. (WG 2018;
There are a number of different and complementary ways of thinking about prevention, but broadly, can be regarded as prevention.
Those with clinical training will likely be familiar with Zola's river analogy (Zola 1970). It describes prevention (stopping everyone from falling into a river and coming to harm e.g. never smoking), 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 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 to co-produce the best outcomes possible, utilising the strengths and people and places have to contribute.
(Feb 2019) sets out six key principles for implementing prevention in Wales:
Although prevention is everybody’s business, as the first point of contact with health services for the majority of people, primary care is a key setting for improving local population health by reducing the future burden of disease caused by avoidable risk factors. Furthermore, many of the inequalities in health status and outcomes derive from the disproportionate distribution of risk in local communities; those at higher risk can therefore benefit from a proportionate increase in preventive attention (offsetting the inverse care law).
In typical primary care clinical settings, the main areas of joint interest are as follows:
However, prevention can be much wider in scope than this, especially when it involves partnership action with a variety of community-engaged stakeholders around a broad range of health conditions or around any of the wider determinants of health (for example, housing or transportation). Irrespective of the scope, preventive actions may be directed at everybody (“whole population approaches”), or at identifiable groups or even individuals (“targeted approaches”). In either case, primary care clusters have a key role to play in advocating—and in some cases directly facilitating—collective action on prevention. These pages set out information and signposting around the key priority areas for prevention, the work that needs to be done, and the resources available to support clusters in playing their part.
link). (WG 2018;