When Prevention Works… Nothing Happens

Boris Lushniak, MD, MPH, FAAD, FACPM, shares his thoughts on recognizing the important but often invisible work of prevention during the COVID-19 pandemic. 

In CEA Winslow’s classic definition, public health is defined as “the science and art of preventing disease, prolonging life and promoting physical health…” (Winslow CEA. The untilled fields of public health. Science. 1920;51(1306):23–33). Public health has certainly evolved with time but the basic premises of the “three p’s” – preventing disease and injury, promoting health (physical, mental, and social well-being) and prolonging a high-quality life still hold. Preventive medicine plays a critical role in achieving the “three p’s”.

The public health model includes an important pathway to achieve the goal of the “three p’s”.  This model consists of four major steps:

1. Surveillance – what is the problem?
2. Risk factor identification—what is the cause?
3. Intervention and evaluation—what works?
4. Implementation – how do you do it? 

The goal of public health is to get to that last stage; the implementation of policies, regulations, and initiatives which would have a positive impact on the health of the population. However, we don’t get to that last stage without robust and scientifically valid information and data from the first three steps. This has been the path in the midst of this pandemic.

This past week we hit a tragic milestone in the COVID-19 pandemic – 1 million people in the U.S. have died as a result of this infectious disease disaster. Using the word “people” here (as opposed to the less emotional “cases”) is critical—each of the 1 million had others who loved them, each had a life story, each is missed.

It is easy for us to accept the premise that, amid this pandemic, we have failed in achieving the “three p’s”.  Undoubtedly in this pandemic pathway, we have had many wrong turns, errors and challenges, especially in the intervention, evaluation and implementation phases of the public health model. But as we reflect on the 1 million people, let us also reflect on the achievements of medical research, preventive medicine, and public health. We do need to ask -- how many people were saved by COVID-19 vaccination and timely adherence to the recommended preventive strategies?  As we mourn the 1 million people, let us remember the saying that “When prevention works—nothing happens.” This reflects the success of prevention strategies, i.e. when vaccinated there was no death or serious disease in that person – nothing happened. It also reflects the fact that oftentimes we do not appreciate, take credit for, or celebrate the successes of prevention. Let’s make something happen and shout out that preventive medicine works!  Let’s keep on track on that bold and noble mission that we have in preventive medicine.