Rose's population strategy of prevention need not increase social inequalities in health
Lindsay McLaren*, Lynn McIntyre and Sharon Kirkpatrick
Department of Community Health Sciences,
International Journal of Epidemiology 2010 39(2):372-377; doi:10.1093/ije/dyp315
“……Geoffrey Rose's 1985 paper, Sick individuals and sick populations, continues to spark debate and discussion. Since this original publication, there have been two notable challenges to Rose's population strategy of prevention.
First, identification of high-risk individuals has improved considerably in accuracy, which some believe obviates the need for population-wide prevention strategies. Secondly, and more recently, it has been suggested that population strategies of prevention may inadvertently worsen social inequalities in health.
We argue that population prevention will not necessarily worsen social inequalities in health, and the likelihood of it doing so will depend on whether the prevention strategy is more structural (targets conditions in which behaviours occur) or agentic (targets behaviour change among individuals) in nature. Also, there are potential drawbacks of approaches that focus on discrete populations (i.e. high risk or vulnerable) that need to be considered when selecting a strategy. Although Rose's ideas need to be continually scrutinized, his population strategy of prevention still holds considerable merit for improving population health and narrowing social inequalities in health…”
Sick individuals and sick populations.
Int J Epidemiol (1985) 14:32–8 .
[Reprinted in Int J Epidemiol 2001;30:427–32].
“…..Aetiology confronts two distinct issues: the determinants of individual cases, and the determinants of incidence rate. If exposure to a necessary agent is homogeneous within a population, then case/control and cohort methods will fail to detect it: they will only identify markers of susceptibility. The corresponding strategies in control are the ‘high-risk’ approach, which seeks to protect susceptible individuals, and the population approach, which seeks to control the causes of incidence. The two approaches are not usually in competition, but the prior concern should always be to discover and control the causes of incidence. ….”
Katherine L Frohlich and Louise Potvin
Structure or agency? The importance of both for addressing social inequalities in health
IJE Advance Access published on January 25, 2010
D. G. Manuel and L. C. Rosella
Assessing population (baseline) risk is a cornerstone of population health planning--looking forward to address new challenges
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