The University of Melbourne
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posted on 2022-08-25, 11:35 authored by Geoff BROWNEGeoff BROWNE

We know that health is significantly socially determined. The environments in which we live, work, eat, travel and socialise, which make up the social determinants of health, all influence public and community health. In the medical models of disease prevention, we consider primary, secondary and tertiary modes of disease prevention.

Tertiary prevention is the prevention of full development of a disease that is already present in a patient, such as the insertion of a stent to limit full expression of cardiovascular disease.

Secondary prevention involves early intervention in the progression of disease to prevent it from developing further, such as prescription of medication to reduce blood cholesterol and regular testing for monitoring.

In public health, the common gold standard for disease prevention is primary prevention, that is prevention of disease occurrence in the first place. In the case if cardiovascular disease, this involves healthy diet and exercise. 

However, a view that healthy diet and exercise is the responsibility of the individual to maintain, ignores the social, environmental, political factors that systematically make these actions harder for some than others. We can therefore look beyond healthy diet and exercise as primary prevention, and look at the factors that make these choices easy, which act as primordial prevention of disease. Good urban planning is therefore at the foundation of public health; 'primordial prevention'.

For example, by promoting active transport infrastructure that increases opportunities for active transport, exercise becomes an easy choice, or a subconscious choice. Healthy urban planning acts upstream to promote health in an effective way, and when distributed fairly, can help remove some of the systematic factors that prevent good health for some groups.