1 Health Promotion and Disease Prevention
Learn how health promotion, prevention levels, individualized risk assessment, screening decisions, and patient-centered care work together to support well-being.
and its foundations
supports people and communities in gaining greater control over factors that affect health. It includes clinical services, such as counseling and immunization, as well as action on the conditions that shape health outside the clinic.
include housing, income, education, transportation, access to nutritious food and health care, and neighborhood safety. Because these conditions influence health opportunities and outcomes, prevention is not solely a matter of individual choices.
Three levels of prevention
Prevention can be grouped by the goal of an intervention. The categories are not rigid boundaries: one person’s care plan may include more than one level.
aims to prevent disease or injury before it occurs. Examples include vaccination, tobacco-use prevention, safer environments, and counseling about health behaviors.
aims to find disease early, often before symptoms, so it can be evaluated and treated. Screening selected conditions in people without symptoms is an example.
aims to limit complications, disability, or loss of function after disease is established. Examples include rehabilitation, chronic-disease management, and monitoring for complications.
Assessing individual risk
estimates the likelihood of a health problem and helps determine which preventive services may be appropriate. It is not a diagnosis and should not be reduced to a single score. Relevant factors include:
Age, development, pregnancy status, and other life circumstances
Personal and family health history, including the age at diagnosis of significant conditions
Symptoms, prior test results, medications, and existing conditions
Health behaviors and exposures, such as tobacco use, alcohol use, sexual health, and occupational or environmental risks
Access to care, language, health literacy, and practical barriers to follow-up
The person’s concerns, goals, values, and preferences
Family history can identify people who may benefit from a different screening approach or further assessment. It can increase risk for some conditions, but does not mean a person will necessarily develop them.
For example, if a close relative developed a cancer at a young age, the patient may need a discussion about whether their screening plan should differ from routine recommendations. The clinician should clarify the family history, assess other risk factors, and consider whether further evaluation or genetic counseling is appropriate rather than assuming the patient has the disease.
Screening benefits, limits, and guidance
A looks for a condition in people who do not have recognized symptoms. A diagnostic test, by contrast, investigates symptoms or an abnormal finding. Screening is useful when evidence supports a favorable balance of benefits and harms for the relevant population, and when appropriate diagnostic follow-up and care are available.
Screening may identify disease earlier, but it is not harmless or perfectly accurate. A may cause anxiety and lead to additional testing. A may provide misplaced reassurance. Screening may also detect abnormalities that would never have caused symptoms or harm; this can lead to unnecessary treatment.
The U.S. Preventive Services Task Force (USPSTF) grades preventive-service recommendations according to the evidence and the balance of benefits and harms:
A and B: In general, the service is recommended.
C: Clinicians may selectively offer the service based on individual circumstances and preferences.
D: The recommendation is against the service.
I statement: Evidence is insufficient to determine the balance of benefits and harms.
A grade guides practice but does not replace checking the recommendation’s population, clinical considerations, and current status.
Planning patient-centered preventive care
Patient-centered preventive care combines evidence with respectful partnership. A practical sequence helps connect assessment to follow-up:
Assess: Review health needs, relevant risks, eligibility for preventive services, and the patient’s priorities and desired role in decisions.
Advise: Explain options in understandable language, including expected benefits, possible harms, uncertainties, and alternatives. Make a clear recommendation when appropriate.
Agree: Ask what matters most to the patient and decide together on a suitable plan. Shared decision-making is especially relevant when benefits are small, evidence is uncertain, or personal preferences strongly affect the choice.
Assist: Provide the service or connect the patient with needed care, while helping address barriers such as cost, transportation, language, or appointment access.
Arrange: Document the plan, schedule follow-up, and revisit decisions when health circumstances or evidence change.
Education should be collaborative rather than a one-way list of instructions. Use plain language, invite questions, and check understanding—for example, by asking the patient to describe the next step in their own words. Set realistic, manageable goals and build on the patient’s strengths.
Tailor prevention to developmental stage and clinical context, including childhood, adolescence, adulthood, older age, and pregnancy. Verify applicable recommendations in current guidance, since recommendations can change as evidence is updated. Effective preventive care brings together evidence-based services and an understanding of each person’s risks, circumstances, and preferences.