Introduction
in the initial stages, to evaluate whether such programmes are effective. Thus, there may be considerable barriers to committing large At first sight, primary preventive medicine amounts of the health care budget at a stage may seem a beautifully simple and effective when the value of the intervention is unknown. idea: identify what causes or increases the risk of developing a disease; make these findings known to the public; the public will then avoid these negative factors; and hence the incidence 2. NIDDM AND PRIMARY PREVENTION PROGRAMMES of the disease will decrease. However, this theoretical simplicity is rarely met in practice. Many barriers need to be overcome at personal, For a primary prevention programme to medical and organizational levels before such have real value, it must target a disease where programmes can be implemented or followed there is a real chance of influencing prognosis. through successfully.
In many ways, non-insulin-dependent diabetes Perhaps the greatest barrier is that mellitus (NIDDM) provides an ideal target for presented by the individual's willingness to preventive interventions: it is a serious contake some responsibility for his/her own perdition with potentially disabling complications, sonal health. Personal responsibility involves yet the condition is, to some extent, reversible, accepting that you are at risk of developing a especially in the early stages. There are risk disease, listening to health advice, being prefactors associated with lifestyle which can easpared to implement lifestyle changes in ily be modified, and at-risk individuals can be response to that advice, and being able to susidentified by screening, even before symptain the changes.
toms present. There will also be considerable bureaucratic barriers to primary prevention programmes. The principal role of preventive intervention should be to reduce human suffering 3. EPIDEMIOLOGICAL STUDIES by reducing the incidence of disease. 1 Although it is difficult to put a monetary value on suffer-Any primary prevention plan must begin ing, health care providers are increasingly with sound epidemiological studies that can expected to do so. Prevention and screening demonstrate that certain factors are actually are costly and although effective prevention causative and not merely associated with the should reduce the costs of treatment, huge condition. sums of money need to be committed, at least Many epidemiological studies have shown major differences in the distribution of NIDDM between countries and between different ethnic Addressee for correspondence: Professor J-Ph. groups in those countries. [2][3][4] It has also been Assal, Chief, Division of Therapeutic Education for shown that lifestyle changes that have occurred Chronic Diseases, Director WHO Collaborating in newly industrialized and developing coun-