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The concept of prevention: a good idea gone astray?

¹ Johns Hopkins University, Baltimore, MD, USA
² Victoria Department of Human Services, Melbourne, Australia
³ Monash University, Melbourne, Australia
⁴ Equipo CESCA, Madrid, Spain
⁵ Canencia de la Sierra (Madrid), Spain
⁶ Caversham Group Practice, London, UK

Correspondence to:
Dr B Starfield, Professor of Health Policy, 624 N Broadway, room 452, Johns Hopkins University, Baltimore, MD 21205-1990, USA; bstarfie{at}jhsph.edu

Over time, the definition of prevention has expanded so that its meaning in the context of health services is now unclear. As risk factors are increasingly considered to be the equivalent of "diseases" for purposes of intervention, the concept of prevention has lost all practical meaning. This paper reviews the inconsistencies in its utility, and suggests principles that it should follow in the future: a population orientation with explicit consideration of attributable risk, the setting of priorities based on reduction in illness and avoidance of adverse effects, and the imperative to reduce inequities in health.