What are the 5 levels of disease prevention?

The 5 Levels of Disease Prevention

Disease prevention is traditionally organized into three main levels—primary, secondary, and tertiary—but contemporary frameworks now recognize five distinct levels: primordial, primary, secondary, tertiary, and quaternary prevention. 1

Primordial Prevention

Primordial prevention targets the prevention of risk factors from ever developing in the first place, focusing on environmental, social, and economic conditions that create disease susceptibility. 1

• This represents the most upstream intervention, addressing population-level determinants before individual risk factors emerge. 1
• Examples include comprehensive clean indoor air laws, tobacco excise taxes, reducing sodium in the food supply, and creating built environments that promote physical activity. 1
• For cardiovascular disease, this means preventing the development of hypertension, diabetes, obesity, and dyslipidemia rather than treating these conditions once present. 1
• Primordial prevention is particularly critical during fetal development, childhood, and adolescence when lifelong health trajectories are established. 1

Primary Prevention

Primary prevention intervenes once risk factors are present to prevent the first occurrence of disease. 1

• This level targets individuals with established risk factors (such as hypertension, prediabetes, or elevated cholesterol) to prevent progression to clinical disease. 1
• Interventions include lifestyle modifications (healthy diet, physical activity, smoking cessation), pharmacological treatment of risk factors, and health education. 1
• For diabetes prevention, lifestyle interventions in people with impaired glucose tolerance can reduce progression to type 2 diabetes by 43% over 20 years. 1
• Primary prevention also encompasses vaccination programs and treatment of acute infections to prevent chronic sequelae (such as treating streptococcal pharyngitis to prevent rheumatic fever). 1

Secondary Prevention

Secondary prevention focuses on early detection and treatment of disease to prevent progression and complications. 1

• This involves screening asymptomatic individuals to identify disease at early, treatable stages. 1
• For chronic kidney disease, this means detecting and managing stages 1-2 (kidney damage with normal or mildly reduced function) to prevent progression to advanced disease. 1
• In rheumatic heart disease, secondary prevention specifically refers to antibiotic prophylaxis in people with prior rheumatic fever to prevent recurrence and disease progression. 1
• Screening programs target high-risk populations based on age, family history, or presence of other risk factors. 1

Tertiary Prevention

Tertiary prevention aims to reduce complications, slow disease progression, and improve quality of life in patients with established disease. 1

• This level addresses patients with symptomatic disease to prevent disability, reduce mortality, and maintain functional capacity. 1
• For chronic kidney disease stage 5 (kidney failure), tertiary prevention includes optimizing dialysis adequacy, managing anemia and bone metabolism, and providing transplantation when appropriate. 1
• In rheumatic heart disease, this encompasses medical and surgical treatment of valvular complications and heart failure. 1
• Comprehensive management includes controlling blood glucose, blood pressure, and lipids in diabetic patients to prevent cardiovascular and microvascular complications. 1

Quaternary Prevention

Quaternary prevention, the newest recognized level, protects patients from excessive or harmful medical interventions and prevents iatrogenic harm. 2

• This concept addresses overdiagnosis, overtreatment, and medical interventions that may cause more harm than benefit. 2
• Quaternary prevention is particularly relevant in the current era of defensive medicine and aggressive screening practices. 2
• Examples include avoiding unnecessary testing in low-risk populations, preventing polypharmacy in elderly patients, and protecting patients from cascades of interventions triggered by incidental findings. 2

Key Clinical Considerations

The distinction between these levels is not always absolute—they represent a continuum of care rather than discrete categories. 1

• Prevention strategies should be tailored to population risk levels, with higher-intensity interventions reserved for those at greatest risk. 1
• The most cost-effective prevention occurs at the primordial and primary levels, though all levels provide value when appropriately applied. 1
• A common pitfall is focusing exclusively on tertiary prevention (treating established disease) while neglecting upstream opportunities for primordial and primary prevention that could prevent disease development entirely. 1