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Health Promotion or Disease Prevention: A Real Difference for Public Health Practice?

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Abstract

It appears that there are two distinct practices within public health, namely health promotion and disease prevention, leading to different goals. But does the distinction hold? Can we promote health without preventing disease, and vice versa? The aim of the paper is to answer these questions. First, the central concepts are defined and the logical relations between them are spelt out. A preliminary conclusion is that there is a logical difference between health and disease, which makes health promotion and disease prevention two distinct endeavours. However, since disease is defined in relation to health, as those kinds of internal processes and states that typically lead to ill health, the difference is smaller than it might appear. Second, in order to answer the practical question whether it is possible to promote health without preventing disease, and vice versa, several kinds of public health interventions are discussed. The conclusion is that while health promotion and disease prevention can be distinguished conceptually, they can hardly be distinguished in practice. Most general measures do both at the same time.

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Notes

  1. State, here, typically refers to a lesion, i.e. a permanent damage of some internal structure, for example, the neural damage caused by a stroke [32].

  2. Talking about defect prevention would not make much sense since most defects are inborn. However, if we have the option of genetic manipulation we might include this type of intervention in prevention.

  3. Immunizing could, of course, equally well be described as disease prevention. However, the distinction between direct and indirect manipulation of disease can hardly be made within prevention, since, apart from the examples given (and perhaps some kinds of genetic manipulations), such manipulations would be equivalent to treatment.

  4. This assumes, as the definition requires, that the cause of the well-being is an internal state, which can be argued for. As soon as the alcohol has been absorbed by the body and is released into the bloodstream we can say that the state is internal.

  5. Note also that we might not see any good reason to reduce moderate drinking in order to maintain manifest health, since, on the whole, the quality-of-life increases that people gain from drinking (moderately) might trump the negative (manifest) health effects of alcohol.

  6. One dilemma in population-based strategies, pertinent here, is that there might be a U-shaped curve relating units of alcohol consumed and longevity, at least for men over 60. If this is true, it means that if we succeed in moving the whole population distribution of alcohol down, we might end up with some people being negatively affected by this, assuming that the hypothesis that a small amount of alcohol (or red wine) is beneficial for health is correct (see [30]).

  7. Screening is sometimes categorized as secondary prevention (e.g. [28]).

  8. Note, however, that we should only promote those health changes which, directly or indirectly, contribute to quality of life [33].

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Acknowledgments

I would like to thank Lennart Nordenfelt, Bengt Brülde, Glenn Laverack, Karin Dahlbäck, the anonymous reviewer, and the participants of “the higher seminar” at IHS, Linköping university, Sweden, for valuable comments on earlier versions of this paper.

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  1. Faculty of Health and Society, Malmö University, 205 06, Malmö, Sweden

    Per-Anders Tengland

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Tengland, PA. Health Promotion or Disease Prevention: A Real Difference for Public Health Practice?. Health Care Anal 18, 203–221 (2010). https://doi.org/10.1007/s10728-009-0124-1

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