1-02: Health Maintenance & Disease Prevention

Preventive medicine can be categorized as primary, secondary, or tertiary. Primary prevention aims to remove or reduce disease risk factors (eg, immunization, giving up or not starting smoking). Secondary prevention techniques promote early detection of disease or precursor states (eg, routine cervical Papanicolaou screening to detect carcinoma or dysplasia of the cervix). Tertiary prevention measures are aimed at limiting the impact of established disease (eg, partial mastectomy and radiation therapy to remove and control localized breast cancer).

Tables 1–1 and 1–2 give leading causes of death in the United States for 2020 and recent estimates of deaths from preventable causes from 2019. The 2020 data demonstrate the large impact of COVID-19 on mortality and continue to show increased mortality rates, generally driven by the effects of COVID-19 as well as increases in deaths from heart disease, unintentional injuries (including overdoses), and Alzheimer disease.

Many effective preventive services are underutilized, and few adults receive all of the most strongly recommended services. Several methods, including the use of provider or patient reminder systems (including interactive patient health records), reorganization of care environments, and possibly provision of financial incentives to clinicians (though this remains controversial), can increase utilization of preventive services, but such methods have not been widely adopted.