Health prevention. Some conceptual references

"Tree that grows crooked... does its trunk ever straighten?"

I asked my precious daughter who was curious about what I was writing, about what she thought about the question with which I started this article: "Tree that grows crooked, does its trunk ever straighten? ", and she very confidently and quickly replied:" never, at Dora's house there is a little tree that whenever I pass hunchback". I think you have some reason, I think it is best to prevent it from being born crooked.

"A society in a position to tackle the preventive step in all its fullness (social, environmental, labor) would suppose such a maturity which, on a Maslow scale, of the satisfaction of collective needs, could be called Social Self-realization "(Niño J, 1996, P. 75). This could undoubtedly be the fundamental reason for the dedication of all this work to the approach to prevention in health.

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Index

1. About the concept of prevention
2. The
3. Conceptual referents.
4. Classifications on levels of prevention

"It is better to be safe than to have to regret."

An inappropriate use of the concept of preventionIt could be the center of multiple confusions that have been present at the level of our health practices.

The word preventionFrom the verb prevent, it is defined as "preparation, a disposition taken to avoid some danger. Prepare something in advance "(Larousse, 1950, p. 755 ). It is clear then that by using this term we are referring to an action of an anticipatory nature. But we would have to ask ourselves, logically and this would be one of the first "dangers", what do we anticipate?

If it is anticipating danger, or if it is anticipating that things may be better than they are. The anticipation may even be just an alert. I consider this apparent play on words essential in the subsequent analysis that I will carry out on prevention practices in health, since the Scientific representation of a term in terms of its personal content is not entirely unrelated to the natural representation of the bearer uncritical.

We might also think, following Foucault, that prevention is the "art of correcting", that it is a means of "good channeling" that, poorly applied, could become dangerous. (Foucault M, 1976). We would have here another danger related to the magnitude of the term and the definition of its limits. The good channeling of prevention is what can define its legitimacy for us, it is what can prevent a possible "perversion" of prevention. I read in a nice novel the following:... "How I knew that scary music was an inseparable companion of all kinds of horrors, instead of enjoying of the theme of love, he was always very pending to detect the minimum variation in the melody to close his eyes and avoid the startle in the soul. Everyone knew that these kinds of anguish were very bad for your health. So much so that the Ministry of Health and Assistance had just banned the inclusion of music from scare in the movies because it affected the viewers' liver tremendously... "(Esquivel L, 1995, P. 76).

Prevention as a concept has its limits, the limits of logic and the natural. Nor does "living is to die" (Colado P, 1996, p. 82). You can get to prevent absurd things to avoid "dangers" to our lives, or already introducing another debated term, to achieve an adequate Health.

The "perversion" of prevention, we can also refer to the interpretation of multiple actions, which without an adequate systematicity and rigor can be classified as preventive, giving an illegitimacy to the concept that makes it lose its value. It then becomes so indefinite and diluted that it prevents recognition and reduces the scientificity of prevention practices.

"The road to hell is full of good intentions."

In recent years, the definitions of Health Policies have come to consider especially the value of Prevention practices. These have been defined above all "as those activities that allow people to have healthy lifestyles and empowers communities to create and consolidate environments where health is promoted and disease risks are reduced.

Prevention involves develop anticipatory actions. The efforts made to "anticipate" events, in order to promote human well-being and thus avoid undesirable situations, are known as prevention "(PAHO, 1995). "Working in prevention is working with the real or hypothetical causes of something that, from letting it go now to treating it later would mean a great cost in money, in suffering, in life expectancy "(Topf J, 1996, P. 6 ).

Prevention in the field of Health implies a scientific conception of workIt is not just a way of doing, it is a way of thinking. It is also a way of organizing and acting, an essential organizer in the conception of a Health System. A Health System is more effective to the extent that it prevents rather than cures. It is more effective from the social point of view - socially, a society with qualitative advances and quantitative in terms of health indicators, which implies a well-being of its members and greater development socioeconomic.

It is more economically efficient - cure implies the investment of a greater amount of economic resources, higher expenses. The most important thing is that it is more effective because, as indicated in the specific field of professional actions of the psychologist, prevention pursues "the identification of those factors that allow promoting health and the implementation of different interventions, in order to keep people healthy "(Guiofantes S, 1996, P. 31) and it is precisely the level of health of the people that is the maximum indicator of efficiency of any health system.

It's hard to think about prevention without thinking about essential changes in the structure of a Health System, but above all in the changes of the ways of thinking, of the theoretical models of departure, of the epistemologies, philosophies and even belief systems so strongly rooted in the professionals who work in the health field and in the different scientific disciplines on which they base their Actions.

These changes that should in our judgment be enunciated in general principles of the actions of prevention in health, would be those that could lead to prevention tasks on a well-defined path channeled. Let us then attempt the assessment in the present work of at least one of the essential points of discussion in which we must work and that could become possible general principles that support prevention practices in the field of health. I am referring to the starting point: to conceptual referents.

Prevention is above all, defined as protection against risks, threats from the environmente, which inevitably means the joint action of the Health Institutions, the communities, and the people who institute them rather than integrate them. At the First International Conference on Health Promotion, held in Ottawa in 1986 with the sponsorship of the WHO, it was pointed out that it was necessary to facilitate the process by which "people can be mobilized to increase their control over and improve their health... to achieve an adequate state of health physical, mental and social well-being... being able to identify and realize their aspirations, to satisfy their needs and to change or adapt to the environment environment". To truly achieve this, it is essential to understand that the development of Health cannot be reduced to the fight against disease, to traditional clinical practices.

Prevention practices cannot then remain tied to old problems and schemes, insisting fundamentally and only on what many call "healthy behaviors" (Kasl S.V., Cobb S. 1966), which are associated with various aspects, areas and vital processes of the human being but seen very punctually, and they have also been, at least partially, vitiated by formalities and conceptual deficiencies fundamental. Opening new perspectives in this sense implies the realization of a critical analysis that goes through the conceptual, technical and instrumental support that these practices have endorsed.

A first analysis should go by way of the delimitation of obstacles, of those things that hinder the task of prevention. Let's look at the most significant ones, taking as a starting point a self-critical vision of some characteristics, of certain ways in which we have often developed our health actions. I will base this part on the works of Dr. Manuel Calviño, where he has addressed this problem (Calviño M, 1995, 1996).

• A first obstacle is the way TO MODEL in which health practices have been conceived. This is something that has been referred to in other works (Calviño M. 1995). In essence, it is a paradigm of operation that is deeply rooted in all professional practices, especially those of the traditional Medical Model, according to which the Professional status gives a position of predominance over the determination of the behaviors to be followed in a certain relationship by those who would be the object of the action professional. The place of the professional is represented as the place of mastery of a model to be achieved (it can be a theoretical model, or even a personal one). There is a dyad, where on one side is the doctor conceived as the only one who has to know what to do, and On the other hand, the patient, like the one who has to do what they are told, the first offers a role model and the second offers a role model. makes. This approach modeling it hides power-subordination relations, giving a kind of "paradigmatic hegemony" to the doctor, and therefore to the "medicalist" understanding of disease and health. This considerably reduces the possibility of an action with equal participation and collaboration, essential elements in prevention actions.
• The second obstacle is given by the concept STATIC of the recipient of the health action. In the case that interests us, it is very clearly established in the name of "the patient", the one on whom the action falls and whose function seems to be to wait patiently. This is expressed in different ways in health practices. Sometimes it seems that the only thing we ask of the people on whom our work falls is that they "let themselves go." They are like inert bodies that will be moved by our action.

Other times our ideas and work procedures are the same for all patients and population groups. Contreras E., concentrating especially on research and evaluation, draws attention to "the little use that has been made of this considerable objectification of states - and inclusive processes - of knowledge, beliefs, practices and behaviors of specific population groups in areas that are also very specific and concrete "(Contreras E. 1994. P. 117). Stolkiner A states that "preventive and community programs must recognize and promote spontaneous forms of re-affiliation of social groups" (Stolkiner A, 1994, p. 52).

On many occasions, prevention problems are intended to be solved at the work table, or at the bureau of officials in the area where an intervention is supposed to be carried out.

• The existence of an inadequate valuation (undervaluation or overvaluation) of the potentialities and capacities of the groups with which one works. The tendency is to think that the patient, or the group of patients cannot by himself, that one must always be with him, either in a directly (consultation, hospitalization, etc.) or symbolically (as a medical prescription, as a medicine, as a method) supporting a social model paternalistic.

Other ways in which this has been expressed inadequate valuation could be the following:

• The image that prevention actions are "poor" health actions or of second importance. This is reinforced in the first place because there is a representation that the problems it addresses are those of the marginality or subjectivity, and secondly because it is the only thing that can be done when there are no other resources.
• On the other hand he draws attention to the "alien" or distant nature of prevention actions for the most favored social groups, with a higher cultural, intellectual and also higher status (Perhaps issues such as smoking, hypertension and more recently AIDS). These groups do not feel called upon in the prevention actions that are carried out, and worse still, it is not actually them who are usually thought of.
• The non-consideration of existing needs in the population groups in which we work, which in recent times has been tried to remedy with the "Prevention on evidence" (which It is the realization of the diagnosis of the needs of the groups on which it is going to work, and based on this the programs are developed preventive).
• Finally, on the part of many specialists who have dedicated themselves to prevention tasks there is a certain vision quite generalized that when working on prevention it is necessary to "lower the level", it is necessary to forget the capacity for abstraction, the complexity intellectual. You have to do things very superficially, almost childishly.

The last hurdle I will refer to is the one of the concentrated attention who have had prevention practices in extreme groups or extreme symptomatology.

This is extremely important when we think about the extent and impact of health prevention practices.

The idea would be: if the carriers of an "anti-health behavior" are important for prevention, more important are those who have not yet developed this type of behavior, nor the favorable, the "prosalud". These would be the risk groups in the correct sense of the word, the ones that are not there yet but may be. If the educational purpose of prevention is to promote the emergence and development of a healthy lifestyle, there is than working with the most prone population segments, those who are found in these risk groups probable. They are "waiting" to see what they do, if they are summoned and given access to a healthier and more enriching way of life, they will probably, most likely, join this company.

As Osvaldo Saidón says: "The concept of risk group has only served to legitimize actions of control and social exclusion over various sectors of the population. The imaginary idea that there would be a kind of immortality for the pure is promoted, that is, for those who are out of risk situations "... (Saidón O, 1994, p. 17)

Calviño M. states that the predominant model of action In prevention practices, it has been fundamentally marked by (Calviño M, 1996):

1. Little importance and interest of medical professionals in the tasks of prevention.
2. Deprofessionalization of prevention actions.
3. Styles of action inappropriate for the real and essential purposes of prevention.
4. Undervaluation of prevention practices.
5. Predominance of an autocratic "medical centrist" model, which does not favor participation.

We could continue the analysis by pointing out the presence of other basic principles that must be considered when undertaking prevention actions.

One of the most important principles is relative to levels of prevention, delimitation of sum importance, since according to the levels in which prevention is worked, the definition of the actions preventive varies.

The classifications on the levels of prevention have been made according to various references such as:

• The types of prevention corresponding to the different moments or stages of evolution of the different diseases (Clinical Model)
• Those corresponding to the different levels of health care (primary, secondary and tertiary) with the specificities that each of them implies (Organizational Model)
• In correspondence with the areas where prevention is carried out. (Functional Model)

Classifications based on a clinical approach model establish the different levels of prevention based on a classification based on what happens in a disease process. We could cite as an example the Caplan and Stevenson S classification that Bleger uses when approaching this point, and that although they were thought to address mental illnesses, they have been applicable in general in the practices of Health.

Caplan refers to the existence of a Primary prevention that would be aimed at reducing the risk of the disease. The secondary prevention which would aim to reduce the duration of the disease, its early diagnosis and effective treatment and the tertiary prevention that she would be focused on avoiding the appearance of sequelae, complications and rehabilitating the subject for their social reintegration. (Bleger, 1994).

Stevenson S. performs sorting in presumptive prevention such as one that tries to modify a condition associated or previous to the disease linked to its etiology, relative prevention the one that, once the disorder appears, is treated to avoid greater consequences, and absolute prevention that goes towards the annulment of the causes and the application of scientific measures (Bleger, 1994).

Guiofantes S raises the acceptance of primary and secondary grades in the conceptualization of prevention in the framework of Health Psychology, based on what was proposed by Santacreu, Márquez and Zaccagnini (Guiofantes S, 1996). "Primary prevention" means those actions aimed at obtaining information that allow us to understand variables or biopsychosocial factors that can cause the appearance of a certain problem, in order to avoid the origin of a deterioration of the Health. While on the contrary, once the above information is obtained, the activities aimed at avoiding or reducing the factors that may aggravate a specific situation constitute secondary prevention... to the extent that the problem has already occurred, any intervention aimed at remedying the damage or deterioration caused cannot be called prevention, but must be conceptualized as treatment. "(Guiofantes S, 1996, p. 31).

These classifications, in one way or another have been present in the health prevention practices that have been carried out for many years, constitute Useful criteria to take into account to recognize the type of work we are doing, but they are limited to a closed and archaic conception of the health process. disease. It therefore has a relative validity, since its knowledge is necessary as one of the general principles to be applied in prevention actions.

Based on a model directed by the way the Health System is organized, the level of prevention has been equated with the level of health care. Thus, many professionals speak that primary prevention is one that is done directly with the community, with different groups population, in polyclinics and clinics and that prevention at the secondary and tertiary level is that carried out in hospitals and centers specialized. This regional classification, although it is useful to locate ourselves geographically, can lead, understood in an isolated context, to the execution of blunders.

This type of classification would be justified, if we are going to refer to the specificity and distinctive features that the carrying out prevention actions at different health levels, where it is possible to talk about the most frequent types of preventive actions and probable. For example, "prevention at the hospital level of health means avoiding complications, reducing risks, facilitating rehabilitation and the quality of life of the patient, is to prepare him to assume responsibility for his self-care, for a better coping and control of his disease. "(Rodríguez G, 1997). If we related this to the classifications previously exposed, we could say that in the hospital or secondary prevention actions are more frequent secondary and tertiary preventive as Caplan says.

These elemental principles, sometimes unknown, have marginalized prevention practices and have intervened in the "anti-preventive" ways of thinking of many health professionals.

Finally we will refer to classification according to a functional criterion, in which we talk about the implementation of prevention directed towards different areas, and within these towards different sectors.

Returning to Bleger, he posits: "In this passage from illness to health promotion, to meeting people in their ordinary and daily occupations and tasks, we We find different levels of organization, among which we have to take into account, fundamentally, institutions, groups, community, society. "(Bleger, 1994, P. 38).

In the Program for the development of Health Psychology in Cuba it is stated:... "to carry out a true preventive work, it is necessary that the action falls on the main groups of the community: pregnant women, preschoolers, schoolchildren, teachers, parents, adolescents, work groups, groups politicians, etc. Preventive measures were incorporated through three fundamental programs: Comprehensive Care for women and children, School care and Occupational Medicine ". (Development Program 2000, 1987, Page14).

These classifications are functional and practical, also allow to delimit fields of action and return once again to the necessary and essential specificities, since one of the general principles in prevention is that to prevent one must know what is going to prevent, its specificities. However, on many occasions I have been able to observe that when focusing attention on the group or area on which I am working, existence is forgotten, sometimes It is totally unaware of it, of the interrelation that the different groups that make it up have also in those particular areas, as has happened to all of us, in a way that For example, from so much prevention in all those classifications mentioned, we forget to prevent within our health institutions, to prevent with ourselves themselves.

Although we focus our gaze on one point, we must not forget the rest of the points that make up the whole. With these classifications of levels we must think a bit: all the points must be present in the moment of our execution, to know better what we are doing, even if we only remain "captivated" by one. The valid thing really turns out to be the very conception of prevention, that although we are carrying out a treatment, it must be present.

I am convinced that there are still many other conceptual referents of principle that I do not intend to cover, but if it is necessary to point out that the prevention in health is a task that requires:

• A way of thinking with conceptual references according to models that must be at the height of the development that contains the concept of prevention.
• The consequent organization of a Health System according to the general principles of Prevention, applicable in all links of the system.
• Carrying out professional actions aimed at fulfilling the Prevent objective.

Carrying out these professional actions implies the rigorous observation of certain elements. Among the most important we can point out:

• The execution of the preventive actions in health it is not the contest of a single scientific discipline. It is everyone's domain and no one's property, there may be specialists in the matter, but all health specialists must carry out preventive actions. It is multidisciplinary in its application and interdisciplinary in its conception.
• Would exist then prevention actions that each specialist can and should carry out (conscious, structured and planned) and preventive actions that groups of different specialists can prepare in the form of programs that would cover different levels of action. All well conceived and executed are equally valid. We should not sit around and wait for the Departments of Health Education to create the programs and we must also participate in the Programs created by the Departments of Education for the Health.
• In the interrelationships between the Medical, Psychological and Educational Sciences, the different techniques with which it operates in the execution of preventive objectives have been developed.
• The Education and Health Promotionare some of the prevention actions that have been implemented with a whole wealth of technical means ( social communication, psychoprophylaxis, etc.) thus achieving the implementation of the preventive task in Health. Each of them has been contributing in their interrelationships, a whole series of instruments, and at the same time a whole mode of action in health prevention.

The technical and instrumental specificity It responds in general terms to: the type of field in which we are going to work, the level of achievement of the proposed objectives, the type of situation or problem on the which we intend to exert our influence, the needs detected in the central object of our preventive actions and the conceptual reference with which let's work.

Two other questions would therefore be another point of debate for future reflections: how do I carry out prevention practices? And with what instruments can I perform these actions?

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

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