A. Look at the conditions in the box.

1. Which are best managed in primary care and which will need to be refered to acute care?
2. Which conditions could primary care help prevent?
3. Which conditions are suitable for follow-up in primary care?
B.Look at the four essay types.

1. What should the writer do in each type?
2. Match each essay type with one of the questions below? (A-D)

3. What topics should be covered in each essay question?
C. Read the title of the text below and the first sentence of each paragraph.
1. What will the text be about?
2. Choose one of the essay questions mentioned above. Write four research questions which will help you to find information for your essay.

D. Read the text.
1. Using your own words, make notes from the text on information for your essay questions.

IN GENERAL…

CARING FOR OUR HEALTH
the role of primary care in disease prevention
at the heart of primary care is the concept of preventive medicine, the belief that diseases or disability should be avoided rather than treated. How to put this into practice is something which has to be considered by all general practitioners (GP’s). On a purely economic basis, the benefits associated with preventive medicine are considerable. Firstly, resources for treatment are not required. In addition, the individual can continue working and contributing to the economy.
Unfortunately, not all conditions can be prevented. Examples, including infectious diseases such as salmonella, which can be acquired from contaminated food. However, conditions such as type 2 diabetes can be largely prevented. With a rapidly ageing population in many developing countries, it is important that prevention should have a high priority in primary care.

Three different aspects of prevention need to be taken into account by GP’s when considering the services they deliver. Firstly, primary prevention is the promotion of health and the prevention of illness, which involves vaccination programmes and efforts to ensure that a safe environment is provided for individuals. Lifestyle modification (providing advice and encouragement to patients on how to change to healthier behaviours) is a tool to change this at an individual level. Smoking cessation clinics are a good example of this. At a community level, awareness campaigns can be used to heighten awareness, for example putting up healthy eating posters. Secondary prevention is concerned with the early identification of disease and the provision of prompt treatment to minimize its damage. This can include running screening programmes, where tests for specific conditions are carried out on a regular basis.

Tertiary prevention is about reducing the effects of disease and disability on the patient, which can involve minimizing the patient’s suffering using appropriate analgesia (pain relief) or promoting self-management of a condition by the patients themselves. A good example of this is with patients who have diabetes.

GPs can also use screening programmes, in which tests are carries out for a specific condition at regular intervals. Screening can deliver considerable benefits in minimizing the effects of disease. When used with profiling, that is, identifying patient likely to develop specific conditions using data from patient records, it can be very cost-effective. Early diagnosis, when conditions or diseases are identified at an early stage, can mean that diseases are easier to treat and can be completely cured in some cases. Diseases screened for include cervical cancer, breast cancer and heart conditions.
However, screening is not suitable for all diseases. Some tests can have high levels of false positives – results falsely indicating the presence of disease.
Further testing may be required for confirmation, which can be upsetting for patients. Tests can also be expensive. Care needs to be taken in deciding whether to set up screening programmes for a specific disease.

In the developed world, targeting three disease-linked behaviours could provide huge benefits in human and financial terms. The first of these is tobacco smoking, causing death through lung cancer and vascular disease as well as chronic obstructive pulmonary disease. It is estimated that around 100 million deaths were directly attributable to tobacco smoking in the 20^th century and that by 2030 this will increase by another billion. Eating too many fatty and sugary foods and not exercising is one of the main causes of diabetes. According to the WHO, diabetes is likely to be one of the most substantial threats to human health in the 21th century, with a projected financial cost of $192 billion by 2020 for the United States alone. If diagnosed early, it can be managed relatively easily.
The final behavior is a reduction in alcohol abuse. Studies show that the misuse of alcohol can be responsible for up to 5% of hospital admissions and can impact significantly on heart disease, diabetes and liver failure. The medical profession has been aware for a long time that population health is improved by prevention. With a rapidly aging population, it is important that a similar conclusion is reached by government in the developed world.