Overall strategies of prevention

Prevention is an action to stop a disease or disability from occurring or progressingin an individual or in a population. Large public health initiatives only began in the 19th century, when it was realized that the health of individual members of society isprofoundly influenced by society's collective characteristics. Primordial preventiontargets prevention of the risk factors themselves, mainly via health education to promotelifestyle changes. Primary, secondary and tertiary prevention arrest the progression ofhearing loss through impairment, disability and handicap. However newer understandingfrom the International Classification of Functioning, Disability and Health (ICF) and theUN Convention on the Rights of Persons with Disabilities (CRPD) links the medical andsocial models of disability with a more positive approach ("function and structure" ratherthan "impairment, "activity" rather than "disability", "participation" rather than"handicap") and the involvement of environmental and personal factors. The rights ofpersons with disabilities are not incompatible with prevention, provided their rights anddignities are recognized.A strategy for effective prevention makes changes in the population as a whole andnot just in the high-risk minority. This occurs through mass public health initiatives orchanges in behaviour that target key risk factors. More data needs to be gathered on theburden caused by risk factors for hearing loss as well as on the size of the burden aroundthe world. This is being addressed by the new Global Burden of Disease initiative.Reducing hearing loss by relatively small amounts in the many people in apopulation with mild, moderate and moderately severe hearing loss will have a greatereffect on the burden than targeting the few with severe or profound loss. The WorldHealth Organisation (WHO) and other organizations are adopting this approach in orderto set up large-scale interventions to make a difference in populations.Excessive noise is an important risk factor for hearing loss; effective populationinterventions are needed against this and other high frequency causes of hearing loss andgeneric risk factors such as poverty, poor personal hygiene, and inaccessible health care.The most effective vehicle for these interventions is Primary Ear and Hearing Care, usingWHO manuals for training in developing countries.The principles and methods of prevention for particular causes have been publicisedby WHO and others. Priorities for action include adopting a comprehensive approach,instituting multisectoral action and enabling sustainable development. Surveillance andmonitoring ensures that interventions are effective and that their cost-effectiveness mustbe compared. However available resources to address hearing loss are stillinappropriately small compared to other NCDs, despite its huge cost to society, and itseffects on equity.© 2012 Nova Science Publishers, Inc. All rights reserved.