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Intervention or Prevention?

Ipuzzlen my eyes as a Public Health MD, there is a fundamental difference between prevention and intervention.   I practice prevention if I proactively address an outcome that has been experienced by some, and I make a concerted effort to trace that condition up stream and work to find opportunities for change, especially for those most at risk.  I practice intervention, on the other hand, when I wait until the disease process has already started and then start treating the symptoms. 

 An example of this is as simple as a vaccine preventable disease like measles. Prevention:  I would have a campaign to encourage immunizations for all, along with wide spread education about the dangers of the disease, how it is spread, and how to protect oneself.   Intervention: If I were practicing intervention, I would tend to focus on treating the individual once they develop symptoms of the disease, and identifying others that may have been exposed.  How would it be if in the population that needed it the most I offered only interventions instead of prevention?  Would we see higher number of sick individuals, higher death rates, and a constant stream of new patients suffering from these preventable illnesses? Would this be acceptable?  I think that most people would agree that this would be an unethical way to approach the wellbeing of a community.

What would happen if I ignored this disease, and did things that made it easier to spread it from person to person, until it reached an epidemic state?  Would there be a sense of urgency in community to contain it? Would a full scale, multidisciplinary response be mounted?   What about if this disease was racism?  I can wager that this disease is more virulent and lethal than most all other diseases that we spend millions of dollars combatting.

I think that instead of practicing prevention, and working up stream to identify the root causes of racism, we choose to practice intervention, waiting until things come to a head like they have in Ferguson, and Baltimore, and in other communities around the country.   I would say our responses are similar to slapping a Band-Aid on a gushing wound.  These Band-Aids can be called increased police presence, or curfews to deal with the acute life threatening events like riots or unrest, but yet activity upstream is peculiarly silent. 

We often forget that there are women and children and mothers and babies in these same communities that have been struck down by this disease, and it is our obligation and duty to mount a true public health response anchored in preventive strategies, and not just passively wait to get involved when things boil over and intervention is called into action.    Just like with vaccines, prevention starts with the children.   Let’s teach tolerance, understanding and compassion to the children, and then just maybe, the future will be healthier for everyone, no matter which side of the police line you stand.

kimwycheKimberlee Wyche Etheridge, MD, MPH is a Leadership Team member with the Every Woman Southeast Coalition


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