Linking high-risk preventive strategy to biomedical-industry market: implications for public health

• Main Authors: Armando Henrique Norman, David J. Hunter, Andrew J. Russell
• Format: Article
• Language: English
• Published: Universidade de São Paulo
• Series: Saúde e Sociedade
• Subjects: Prevenção de Doenças; Saúde Pública; Prevenção Quaternária; Medicalização; Mercantilização; Medicina Baseada em Evidências
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-12902017000300638&lng=en&tlng=en

Abstract This paper takes Geoffrey Rose’s concepts on preventive strategy as the basis for theoretical framework to critically analyse the current approach to disease prevention. Rose’s “continuum of risk and severity” has widened the scope for preventive actions and underpins two approaches: high-risk strategy (HRS) and population strategy (PS). Both of them produce paradoxes: HRS, despite having a good harm-benefit ratio, offers little impact on public health; PS has greater impact on public health, but offers minimal benefit at individual level. We argue that HRS is being misapplied by reducing cut-off points for preventive interventions to impact morbimortality attributed to specific diseases. This tends to medicalize prevention, producing more disease related phenomena through screening techniques, and inducing individual affective reactions, which require action in the present to secure better future health. This context has paved the way for speculative preventive medicine, which perceives health as a commodity but ignores its implications for public health services.