Annex 2.A: Intervention Categories and Pertinent Policy Instruments
The term intervention is used to denote actions taken by or for individuals to reduce the risk, duration, or severity of an adverse health condition. Policy instruments encourage, discourage, or undertake interventions. Stopping smoking, for example, is an intervention that an individual can take to reduce his or her risk of a range of diseases, and taxing tobacco products is a potential instrument of government policy to encourage this intervention. Interventions are divided into those that are population based and those that are personal as follows:
-
Population-based primary prevention is directed toward entire populations or population subgroups. These interventions fall into three broad categories: personal behavior change, control of environmental hazards, and population-oriented medical interventions (for example, immunization, mass chemoprophylaxis, and screening and referral).
-
Personal interventions are directed toward individuals and can be provided at home; at clinics (community, private, work-based, or school-based); at district hospitals; or at referral hospitals.
Primary prevention aims at reducing the level of one or more identified risk factors to reduce the probability of the initial occurrence of a disease (for instance, providing medication for established hypertension to prevent stroke or myocardial infarction).
Cure of a condition aims at removing the cause and restoring function to what it was before.
Acute management consists of time-limited interventions that decrease the severity of acute events or the level of established risk factors to minimize their long-term effect (for instance, providing thrombolytics for acute myocardial infarction or angioplasty to reduce stenosis in coronary arteries).
Secondary prevention (or chronic care) consists of ongoing interventions aimed at decreasing the severity and frequency of recurrent events of chronic or episodic diseases (for instance, providing selective serotonin reuptake inhibitors for severe unipolar depression).
Rehabilitation aims at restoring or partially restoring physical, psychological, or social function resulting from a previous condition.
Palliation aims at reducing pain and suffering from a condition for which no cure or means of rehabilitation is currently available. It may range from the use of aspirin for headaches to the use of opiates to control terminal cancer pain.
Policy instruments are activities that governments or other entities that wish to encourage or discourage interventions or to expand the potential interventions could undertake. The following are five major instruments of policy:
-
Information, education, and communication seek to improve the knowledge of individuals and service providers about the consequences of their choices.
-
Taxes and subsidies on commodities, services, and pollutants seek to effect appropriate behavioral responses.
-
Regulation and legislation seek to limit the availability of certain commodities, to curtail certain practices, and to define the rules governing the financing and provision of health services.
-
Direct expenditures seek to provide or to finance the provision of selected interventions (such as immunizations); to provide infrastructure (for instance, medical schools) that facilitates the provision of a range of interventions; or to alter infrastructure so as to influence behavior (for example, by installing speed bumps).
-
Research and development, either undertaken directly or encouraged through subsidies, are central to the goal of expanding the range of interventions available and reducing their costs.
Source: This annex was prepared by Thomas Gaziano, Dean Jamison, and Sonbol Shahid-Salles.
