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Prevention of Premature Death and Disability

The most important health goal for most people, even if we don’t think about it very often, is prevention of premature death and disability.  Preventive strategies are often considered in three categories, primary, secondary, and tertiary.


Primary prevention refers to things you can do to prevent problems from developing. Examples include eating a healthy diet, being physically active, getting sufficient sleep, getting recommended immunizations, avoiding hazardous substances such as tobacco and too much alcohol, and reducing the risk of injuries by wearing seat belts and wearing a helmet when riding a bicycle or motorcycle. Primary prevention is by far the most effective type of prevention.


Secondary prevention involves finding problems after they have developed but before they begin to cause symptoms. This form of prevention is called screening. Pap smears to detect cervical cancer, mammograms to detect breast cancer, colonoscopies to find colon cancer, blood tests for prostate cancer, and CT scans to find early lung cancers are all examples of secondary prevention, as are measurements of blood pressure, blood sugar, and cholesterol.


Tertiary prevention involves the treatment of already present, symptomatic conditions to prevent them from causing premature death or disability. As a general rule, tertiary prevention is the least effective and most expensive form of prevention.

Since primary prevention is usually more effective than secondary and tertiary prevention, most people would be wise to focus on primary preventive measures first.  However, the choice of strategies depends a great deal on your personal risk profile.  For example, if you smoke cigarettes, you can gain more additional life (11 minutes per cigarette) from quitting smoking than from any other preventive measure. Health risk appraisal (HRA) tools can sometimes help you to identify preventive measures likely to be most helpful to you.

While staying alive is an important goal for most people, most of us can think of conditions under which death would be a blessing. Think about circumstances that would be so intolerable to you that you would not want antibiotics to be given if you had pneumonia.  Make sure you communicate that information to everyone who might be involved when decisions have to be made, especially close family members. 



While prevention of premature death and disability is an important goal for most people, optimizing current quality of life is also important, and those two goals are often in direct conflict.

Taking medications, following a special diet, having regular medical check-ups, having regular blood tests, or doing anything else that you would prefer not to do in order to increase your length of life, will almost always reduce your quality of life to some degree.  It is therefore important that you discuss with your doctor the size of the expected benefit, and the potential costs, both financial and otherwise, so that you can decide whether the negative effects on your quality of life are worth the positive benefits on your length of life.

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