Primary Prevention and the Three Levels of Health Care

In light of what may well be remembered as the Coronavirus Crisis of 2020, I am setting aside other projects and turning more attention to issues of public health education — and, hopefully, philosophy’s relevance to public health. Although it’s not noted anywhere in my credits, I earned a public health degree back in the late ‘90s — specifically, a degree in Health Promotion and Education. I mention this only to establish credibility for what follows. Disillusioned with academia even then, I was thinking of a second career that didn’t happen. But with a few blog posts, maybe it’s not too late!

My two biggest takeaways from that two-year course of study were: (1) the importance of the idea of systems as fundamental to our understanding not just of health but of reality generally; and (2) something more health specific: what the folks at Carolina called the Three Levels of Prevention.

Later, it struck me that the phrase Three Levels of Prevention was a misnomer. Once you got above the first level, it was too late to prevent illness or worse. Then one day I hit upon the correct phrase: the Three Levels of Health Care.

Those wishing to take a major deep dive into systems theory as a foundation for health promotion should go here — to the refereed journal article Dr. Ureda and I were able (after a long struggle with the data-drivenness academic box) to have published. It’s not essential for what follows, though, and I link to it only for completeness’ sake.

We turning, then, to the Three Levels of Health Care:

Primary Prevention, Secondary Treatment, and Tertiary Care.

Each one sketched in a couple of sentences:

Primary Prevention is everything you can (and should) do to avoid getting sick, injured, etc. Like the phrase says, it is preventive, not curative.

Secondary Treatment is what the doctor does (one hopes!) when you’re sick and want to get well!

Tertiary Care is what facilities (e.g., rehabilitation clinics, and many nursing homes) do for those whose lives have been permanently disrupted by strokes, severe heart attacks, injuries, and sometimes chronic conditions. If you’re in a position of needing Tertiary Care, you’re only likely to improve marginally if at all.

Best to avoid ever getting in that position if possible. Practicing Primary Prevention can help, including avoiding personal bankruptcy or bankrupting your loved ones.

So what is Primary Prevention? As just said, and now we expand:

It is everything you can do to avoid getting sick. (If by some chance you want this in systems language, it is everything you can do to make your body systems, especially your immune system, stronger, more resilient, and therefore more able to repel or parry or neutralize invasions by outside agents — such as coronaviruses!)

Primary Prevention therefore includes eating nutritious food, obviously. Nutritious food includes plenty of colored vegetables. It includes plenty of fresh fruit. It includes nuts. It includes eggs. We won’t get into the full chemistry of the justification for these (unless someone comments and asks for supporting links). These claims are common enough. But what isn’t as common is putting them inside a larger frame of reference.

To practice Primary Prevention, there are things you should eat or drink only in moderation at best, and a few things you should avoid putting in your body at all costs.

Drink coffee, tea, and alcoholic beverages in moderation, if at all (and these are things you can live without). For what it’s worth, I’m one of those people who loves his early morning coffee, but I limit myself to no more than two cups. (Well, sometimes it’s two and a half cups — but that’s all!).

For meat-eaters, white meat is healthier than red meat, which your digestive system has to work harder to break down. My nod to vegetarians: you can also survive without eating meat.

Here are the things best avoided or kept to a bare minimum: white sugar (except perhaps cane sugar), white bread, and foods made with large amounts of flour or filled with preservatives, soft drinks. Especially avoid Light (or Lite) soft drinks! And any of the many variations on that theme promoters use to lure your attention. Avoid fried foods as well. (But they taste so good, some readers will be thinking right about now. I get it. Good taste is hard to resist. They’re that way on purpose, filled with mildly addictive flavor enhancers designed to keep you coming back for more. Never forget that food corporations are not in the health business, they are in the money business.)

You may have to search far and wide for healthy food and healthy beverages. But that’s today’s marketplace.

To practice Primary Prevention, learn to read food labels. Avoid sucralose and other artificial sweeteners. Avoid frozen foods the labels for which (by law) list chemical ingredients whose names you’ll probably have trouble pronouncing. I’ve found that a good layperson’s guide to what not to purchase in stores is that if you can’t pronounce, much less identify, the ingredients in some food product, it’s probably best to leave it on the shelf.

And perhaps most importantly of all, if you want to practice Primary Prevention — do not smoke cigarettes!

I think I decided back when I was a little kid that I’d never let myself be tempted by the smoking lure, no matter what.

We had a neighbor who we watched die from lung cancer. I was maybe 5 years old. It was both my first encounter with human mortality, and with the realization that if you want to live a long and healthy life, there are certain things you just plain should not do.

And you know what? I’ve never been tempted to smoke. Not once. Not in the slightest.

You know what else? I disagree with those who say that secondhand smoke isn’t real, and isn’t a public health threat.  Therefore if local governments wish to force restaurants and bars to ban indoor smoking, I have no problem with that!

Primary Prevention is about more than eating and not smoking, of course. It includes getting exercise and training for such, if necessary. It includes managing and if possible, reducing your stress with prayer, meditation, and so on. It includes getting enough uninterrupted sleep. It includes cultivating a mindset of calm: as the Stoics would say, distinguishing what we can control from what we cannot control and focusing our minds accordingly.

Christians say God is ultimately in control. Okay, but maybe He doesn’t want us to stay in our comfort zones. (I’ve noticed: many Christians often say God is in control as a kind of mantra, designed for comfort instead of being part of an action plan. In which case, even if true it doesn’t get you anywhere.)

The Coronavirus Crisis of 2020 has added to the list of do’s and don’ts of Primary Prevention.

Do: wash your hands frequently. Wash your dishes and counters carefully. The virus can’t live for long on surfaces, but it can live long enough. Wash your clothes — daily, if possible. As for face masks, I’m unsure if they really protect you from getting an airborne virus, but they will discourage you from putting your fingers and hands near your mouth or on the covered portions of your face.

Don’t: touch objects in public (e.g., handrails) if you can avoid it. Don’t touch or mingle with strangers in public places.

Social distancing has become another mantra that wasn’t even in our vocabulary a month ago. The idea is fundamentally sound, however. The problem with this virus is its long incubation period. I don’t think anyone knows for sure how long it can gestate in your system before you show any symptoms. Most say two to 14 days, but some say longer. Some people appear to test positive for the virus, which means they can transmit it to others, but never manifest any symptoms at all.

Our systems are often quite different from one another.

As I noted last week, many of the public precautions being urged or taken (e.g., letting people into grocery stores only a few at a time) are sensible.

And by the way, in last week’s wide-ranging discussion I observed that certain populations are more vulnerable to the coronavirus than others. The elderly especially, but all those with immune systems partly compromised by chronic conditions, and those with respiratory problems. The coronavirus attacks the respiratory system, after all — a reason most sufferers complain of shortness of breath and sometimes of continued breathing problems after other symptoms have gone away.

I never meant to suggest that if you’re not in one of those populations you can’t get Covid-19. You can. So take precautions.

And if you’ve tested positive, or think you have it based on known common symptoms, do the right thing and self-quarantine after contacting a doctor for advice.

My main purpose here has been to discuss Primary Prevention, place it in context, and perhaps knock open some doors that may lead to a solution to the health care crisis in the U.S. which, again, goes beyond this particular crisis. Even if the coronavirus were to vanish into thin air, the wide range of chronic conditions managed for Big Pharma’s profits, the high cost of health care and health insurance more broadly, and in general, the realization that encouraging a healthy population is not in the interests of this society’s moneyed elites, would not go away.

Therefore I have my doubts that Primary Prevention will ever be taught as part of any public school curriculum. Nor will you see it discussed in corporate-controlled media outlets.

Unless, of course, there are vast changes in the dominant priorities in our present-day political economy, which prioritizes money and profit above all else.

You might encounter Primary Prevention for the first time in public health graduate programs administered by those damned economic lefties, on the Internet if you know where to look, and on private (nonmonetized) blogs like this one.

Be all this as it may, I think we’ve made a pretty solid case that Primary Prevention is worth learning about and worth practicing. After all, whether it is taught in schools or not, whether it’s promoted on any large scale or not, it’s one of those things you can learn on your own. You can decide, here and now, to take charge of your education for Primary Prevention, and choose to practice Primary Prevention. You can take control of your own health, that is. If you don’t,  you’re only asking for a mountain of grief, possibly long-term, but possibly immediately — especially these days!

About Steven Yates

I have a Ph.D. in Philosophy from the University of Georgia and teach Critical Thinking (mostly in English) at Universidad Nacionale Andrés Bello in Santiago, Chile. I moved here in 2012 from South Carolina. My most recent book is entitled Four Cardinal Errors: Reasons for the Decline of the American Republic (2011). I am the author of an earlier book, around two dozen articles & reviews, & still more articles on commentary sites on the Web. I live in Santiago with my wife Gisela & two spoiled cats, Bo & Princesa.
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