Abstract
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.
Highlights
Este artigo aborda os conceitos de Geoffrey Rose sobre estratégia preventiva como base para análise teórico-crítica da abordagem atual para a prevenção de doenças
Section two presents Roses approach to prevention: high-risk strategy (HRS) and population strategy (PS)
We argue that HRS has become mainstream in prevention because it fits a neoliberal economic approach to viewing health as a commodity
Summary
Este artigo aborda os conceitos de Geoffrey Rose sobre estratégia preventiva como base para análise teórico-crítica da abordagem atual para a prevenção de doenças. If applied comprehensively, EBM could integrate ‘basic scientific principles, the subtleties of clinical judgment, and the patient’s clinical and personal idiosyncrasies’ (Greenhalgh; Howick; Maskrey, 2014) It has become policymakers’ main instrument for assessing effectiveness of biomedical technologies and treatments. According to Harrison (1998), EBM has been used as a method for rationing healthcare’s finite budget It frees politicians from difficult rationing decisions by seeming to offer a ‘neutral’ objective approach in decision-making processes on current and new biomedical technological innovations. Its hierarchical framework for assessing available medical knowledge has strengthened the medical authority (e.g. medical experts and researchers) while simultaneously reducing that of clinicians It allows the production of clinical guidelines that doctors are obliged to adopt (Harrison; Moran; Wood, 2002). Section two presents Roses approach to prevention: high-risk strategy (HRS) and population strategy (PS). We argue that HRS has become mainstream in prevention because it fits a neoliberal economic approach to viewing health as a commodity
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