Intended for healthcare professionals

Rapid response to:

Opinion

Time to ban the word “prevention”

BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p2212 (Published 25 September 2023) Cite this as: BMJ 2023;382:p2212

Rapid Response:

To prevent or to care? That is not the question

Dear Editor

Prevention seems to be the magic solution to save healthcare systems (1). It is indeed appealing for policymakers who assume that more prevention at an individual level would mean less care and, consequently, help save money. This is, however, probably not true as prevention activities and care grow in parallel in most healthcare systems, and because both are necessary. Choosing to prevent or to care might not be the question to solve. The real question is whether we have the healthcare resources and organization to provide prevention activities in addition to usual care. And how to respond to this question is a major challenge in most healthcare systems.

Preventive services require important resources. For example, the time needed by physicians to provide all preventive services recommended by the USPSTF across a representative panel of 2500 adult patients has been estimated to be more than 8 hours per working day (2). If we want to deliver these services, we have therefore to change the way we organize individual-level prevention and care activities. Within an interprofessional approach, involving nurses and pharmacists is a strategy, as strong evidence has shown that they are efficient in the provision of preventive interventions (3, 4). Their implications in multiple types of preventive services and in the management of chronic diseases are therefore growing in many jurisdictions.

However, we will need more than that, for two reasons. First, the aging of the population will necessitate not only more prevention but also more care as the burden of chronic disease will increase. Second, there is a worldwide shortage of healthcare workforce, which is, currently, already under pressure. Rather than expecting too much from overwhelmed healthcare providers, it will be necessary to strengthen population-level prevention, i.e., by addressing eco-, socio-, and economic determinants of health to build environments favorable for health (5).

Arnaud Chiolero, professor of public health (1), and Valérie Santschi, professor of health services research (2)
From the 1) Population Health Laboratory (#PopHealthLab), University of Fribourg, Switzerland; and 2) La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland

References
1. Smith R. Time to ban the word "prevention". BMJ 2023; 382:2212.
2. Privett N, Guerrier S. Estimation of the Time Needed to Deliver the 2020 USPSTF Preventive Care Recommendations in Primary Care. Am J Public Health 2021; 111(1):145-149.
3. Santschi V, Wuerzner G, Pais B, Chiolero A, Schaller P, Cloutier L, Paradis G, Burnier M. Team-Based Care for Improving Hypertension Management: A Pragmatic Randomized Controlled Trial. Front Cardiovasc Med 2021; 8:760662.
4. Gastens V, Kiszio B, Del Giovane C, Tsuyuki R, Paradis G, Chiolero A, Santschi V. Pharmacist interventions to improve hypertension management: protocol for a systematic review of randomised controlled trials. BMJ Open 2022;12(5):e059399.
5. Frieden TR. A framework for public health action: the health impact pyramid. Am J Public Health 2010; 100(4):590-5.

Competing interests: No competing interests

08 October 2023
Arnaud Chiolero
Professor of Public Health
Valérie Santschi, Professor of Health Services Research, La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
Population Health Laboratory (#PopHealthLab), University of Fribourg, Switzerland
Route des Arsenaux 41, 1700 Fribourg