MONIQUE MAVRONICOLAS PREVENTING ILLNESS AND LIVING WITH ILL HEALTH

1. Introduction
The main objective of this paper is to understand the key characteristics of early
intervention with different methods in preventing ill health. The aim will be to explore a
specific disease Cervical Cancer and the factors that may include possible causes,
prevention, campaigns, treatment, maintenance and statistics surrounding the disease.

Healthcare professionals often use illness and disease interchangeably, however, one
should understand that there is a distinct difference between the two. Tony Ingram defines
them as follows: Disease best refers to an abnormal condition affecting an organism. This
abnormal condition could be due to infection, degeneration of tissue, injury/trauma, toxic
exposure, development of cancer, etc. This is what needs to be cured, especially if its lifethreatening. Illness best refers to the feelings that might come with having a disease.
Feelings like pain, fatigue, weakness, discomfort, distress, confusion, dysfunction, etc. the
reasons people seek healthcare and usually the way people measure their success with
treatment. (http://www.bboyscience.com/disease-vs-illness/).

2. Preventing illness and disease

Healthcare professionals aim to prevent disease than treat the disease and the illnesses
that accompany a disease. Prophylaxis from disease come in many forms, one will often find
that established factors such as the environment, the economy, cultural, social and religious
behaviour will bear influence on these. Preventative measures may include diet, lifestyle,
medication, vaccination, hygiene, religion, meditation and various other forms. History has
taught us that prevention could be broken up into different stages, a mandate to keep the
disease from progressing one could introduce more or new preventative methods. There are
three stages or preventative care, the table below lists the definition of the different stages.

Level

Primary

Definition

Methods to avoid manifestation of disease through excluding possible causes or

MONIQUE MAVRONICOLAS PREVENTING ILLNESS AND LIVING WITH ILL HEALTH

prevention

increasing resistance to disease.

Secondary
prevention

Methods to identify and to attempt to eliminate in an existing disease before the

appearance of symptoms.

Tertiary
prevention

Methods to decrease the negative effect of the suggestive disease, in order to

avoid disability or death, through rehabilitation and management (by means of
medically, chemically, psychologically, sociologically and surgically)

Primordial prevention is the first step in preventative care and consist of the
engagements one has to do to lessen the risks for future illness and disease. It focuses on
comprehensive health factors that could prevent one from the risks of contracting a disease.
Examples of primary prevention methods will include health promotion campaigns against
binge drinking and smoking, eating 5 a day and increasing sport programmes within schools.
These primary prevention methods aim to prevent the onset of certain diseases by shifting
our bad behaviours that could lead to disease or creating a better resistance to the exposure
of illness and disease.

The objectives of primary prevention usually focuses on specific causes and risk factors
which could be prevented through vaccination or immunisation. There has been great
controversy around immunisation and vaccination within the world. UK healthcare providers
(public and private) have done a huge amount of research and have invested a great deal in
informing and educating the public on the pros and cons of getting vaccinated and the
specifics relating to the specific vaccinations. It is an individuals choice whether or not to be
vaccinated or to have their children vaccinated, however, in the USA the government has
made very few exceptions for children to enter public schooling without being vaccinated and
generally have a no vaccination, no school policy.

In an attempt to increase preventative primary care the NHS releases a full vaccination /
immunisation schedule every year as illustrated in Figure 1. GP Practices are also
encouraged to invite and remind the people on their practice role of these vaccinations as
and when required, in addition to this, schools and sure start centres also follow up on
vaccinations within children.

MONIQUE MAVRONICOLAS PREVENTING ILLNESS AND LIVING WITH ILL HEALTH

Primary preventative approaches often involve active and passive approaches, example
of an active preventative approach would be regular tooth brushing and flossing to prevent
dental decay and dental related disease, whereas a passive approach would be where a
water company would add fluoride to drinking water or sites using water that is not suitable
for consumption have warning signs.

Figure 1 Complete routine immunisation schedule 2013/2014

(https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/227651/8515
_DoH_Complete_Imm_schedule_A4_2013_09.pdf)

When to
immunise
Two months old

Three months old

Four months old

Between 12 and 13
months old within a
month of the first
birthday
Two and three
years old3

Diseases
protected against

Vaccine
given

Immunisation
site1

Diphtheria, tetanus, pertussis (whooping

cough), polio and Haemophilus influenzae
type b (Hib)

DTaP/IPV/Hib (Pediacel)

Thigh

Pneumococcal disease
Rotavirus

PCV (Prevenar 13)

Rotavirus (Rotarix)

Thigh
By mouth

Diphtheria, tetanus, pertussis, polio and

Hib

DTaP/IPV/Hib (Pediacel)

Thigh

Meningococcal group C disease (MenC)

Rotavirus

Men C (NeisVac-C or Menjugate)2

Rotavirus (Rotarix)

Thigh
By mouth

Diphtheria, tetanus, pertussis, polio and

Hib

DTaP/IPV/Hib (Pediacel)

Thigh

Pneumococcal disease

PCV (Prevenar 13)

Thigh

Hib/MenC

Hib/MenC (Menitorix)

Upper arm/thigh

Pneumococcal disease
Measles, mumps
and rubella (German measles)

PCV (Prevenar 13)

Upper arm/thigh

MMR (Priorix or MMR VaxPRO)2

Upper arm/thigh

Influenza4 (from September)

Flu nasal spray (Fluenz) (annual)

(if Fluenz unsuitable, use inactivated flu
vaccine)

Nostrils
Upper arm

Diphtheria, tetanus, pertussis and polio

dTaP/IPV (Repevax) or
DTaP/IPV (Infanrix-IPV)2

Upper arm

Measles, mumps and rubella

MMR (Priorix or MMR VaxPRO) (check

first dose has been given)2

Upper arm

Cervical cancer caused by human

papillomavirus types 16 and 18 (and
genital warts caused by types 6 and 11)

HPV (Gardasil)

Upper arm

Crown copyright 2013 Available as a pdf only. Published

by Public Health England 2013.

Three years four

months old or soon
after
Girls aged 12 to 13
years old

Tetanus, diphtheria and polio

Td/IPV (Revaxis), and check MMR status

Upper arm

Around 14 years old

MenC

MenC (Meningitec, Menjugate or NeisVacC)2 6

Upper arm

65 years old

Pneumococcal disease

PPV
Pneumococcal
vaccine (Pneumovax II)

polysaccharide

Upper arm

3
The safest way to protect children and adults

Immunisation Informatio

MONIQUE MAVRONICOLAS PREVENTING ILLNESS AND LIVING WITH ILL HEALTH

65 years of age and

older

Influenza4

Flu injection (annual)

Upper arm

70 years old

Shingles (from September)

Shingles (Zostavax)

Upper arm
(subcutaneous)

Immunisations for those at risk7

At birth, 1 month old,
2 months old and 12
months old

Hepatitis B

Hep B

Thigh

At birth

Tuberculosis

BCG

Upper arm (intradermal)

Six months up to two

years

Influenza4

Inactivated flu vaccine (annual)

Upper arm/thigh

Two years up to under

65 years

Pneumococcal disease

PPV Pneumococcal polysaccharide vaccine

(Pneumovax II)

Upper arm

Over two up to less

than 18 years
Influenza4 (from September)

Flu nasal spray (Fluenz) (annual)

(if Fluenz unsuitable, use inactivated flu
vaccine)

Nostrils
Upper arm

18 up to under 65
years

Influenza4

Inactivated flu vaccine (annual)

Upper arm

Pertussis

dTaP/IPV (Repevax)

Upper arm

From 28 weeks of
pregnancy8
1

Where two or more injections are required at once,

these should ideally be given in different limbs.
Where this is not possible, injections in the same
limb should be given 2.5cm apart. For more details
see Chapters 4 and 11 in the Green Book. All
vaccines are given intramuscularly unless stated
otherwise.

NB Where a vaccine is manufactured by more than

one supplier, it may, on occasion be necessary to
substitute an alternative brand.
3
This is defined as children aged two or three years
(but not four years) on 1 September 2013.
4
The vaccine is given prior to the flu season usually
in September and October.
2

This vaccination will be introduced during the

2013/14 academic year.
The vaccine supplied will depend on the brands
available at the time of ordering.
7
See individual chapters of the Green Book for
clinical risk groups.
8
See CMO letter of October 2012.
5

Secondary Preventative methods are the systematically designed to detect the start or
beginning or even early stages of a specific disease and allowing intervention and an
attempt to control the disease before comprehensive symptoms develop. Early interventions
are not only cost effective but also a way of identifying causes and impacts that could be
illuminated in order for one to prolong ones life. Routine checks, whether cholesterol, blood
sugar, cervical screening and mammograms are regularly the first step that leads to early
intervention before other symptoms appear.

The last and final step of preventative care could possible also be seen as manageable
care, these methods are known as tertiary preventative methods. When a patient reaches
tertiary care the disease has in all probability been established and we could assume that
the preventative methods used in primary prevention has been unsuccessful, however, due
to the second preventative stage, the disease were identified in the early stages and have
possibly minimised the full impact of the disease, The focus of tertiary prevention include,
preventing pain and more damage to the human body, attempting to stop any further
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MONIQUE MAVRONICOLAS PREVENTING ILLNESS AND LIVING WITH ILL HEALTH

progression or any more complications that the disease has already caused and attempting
to reinstate better health and increase the standard of living to the patient.

Figure 2 - Examples of primary, secondary, and tertiary prevention interventions

targeting individuals and populations

Disease

Intervention Primary
level

Secondary

Tertiary

Colorectal
cancer

Individual

Counselling on healthy
lifestyles: dietary
counselling for people at
risk of colorectal cancer,
etc.

Hemoccult stool
testing to detect
colorectal cancer
early

Follow-up exams to
identify recurrence or
metastatic disease:
physical examination,
liver enzyme tests,
chest x-rays, etc.

Population

Publicity campaigns
alerting the public to the
benefits of lifestyle
changes in preventing
colorectal cancers;
promotion of high fibre
diets; subsidies to help
people access exercise
programmes; anti-smoking
campaigns

Organized
colonoscopy
screening
programs

Implementation of
health services
organizational models
that improve access to
high-quality care

Individual

Counselling on safe drug

use to prevent hepatitis C
virus (HCV) transmission;
counselling on safer sex

Screening for
HCV infection of
patients with a
history of
injection drug
use

HCV therapy to cure

infection and prevent
transmission

Population

HCV prevention includes

safer sex practices,
programmes to discourage
needle sharing among
intravenous drug users,
etc.

Establish a
universal testing
system for HCV
in high risk
groups

(Similar to primary
prevention): ensuring
close control of high risk
sites such as tattoo
parlours that have been
associated with
outbreaks

Individual

Nutrition and exercise

counselling

Screening for
diabetes

Referral to cardiac
rehabilitation clinics

Population

Built environment
favourable for active
transport (walking,
bicycling rather than using
a car)

Community level Implementation of

weight loss and
multidisciplinary clinics
exercise
programs to
control metabolic
syndrome

Infectious
diseases:
hepatitis C

Metabolic
syndrome

MONIQUE MAVRONICOLAS PREVENTING ILLNESS AND LIVING WITH ILL HEALTH

3. Cervical Cancer
According to Cancer Research UK in 2011 there were 3064 woman diagnosed with
cervical cancer and in 2012, 919 woman
died as a result of cervical cancer even
though it is considered as the most
preventable cancer. Cervical cancer
deaths have decreased with more than
71% since 1970, yet Cancer Research UK
believes that the main cause of cervical
cancer could have a 100% prevention rate
through early detection: Cervical
screening can prevent around 45% of
cervical cancer cases in women in their
30s, rising with age to 75% in women in
their 50s and 60s, who attend regularly (www.cruk.org/cancerstats).
In 2009 the UK had an extra 400 000 women who went for cervical screenings after the
death of Jade Goodie. Unfortunately the Jade Goodie effect has worn off and new figures
from Cancer Research UK shows that one in three women refuse or make excuses to go for
their cervical screenings and One in five women do not attend screening when invited and
many delay it for more than a year. Awareness campaigns has been launched to encourage
women to attend cervical screenings in the UK include:

GSK in support of Joes Cancer trust launched and new campaign TIME TO
TEST where employers commit to give employees flexible time off to have their
cervical screening tests done

Dr Dawn Harper did a smear test on LIVE television as part of the

NoFearGoSmear Campaign, to show people how 5 minutes of your time might
save your life.

Cervical Screening Awareness Week (CSAW - 15 - 21 June 2015) is a UK-wide

initiative led by Jo's Cervical Cancer Trust. The week aims to highlight the
importance of cervical screening (smear) and how attending a screening
invitation can help to prevent cervical cancer.

NO EXCUSES is a cervical screening campaign launched and produced by NHS

Milton Keynes and Northamptonshire and NHS Leicester, Leicestershire and

MONIQUE MAVRONICOLAS PREVENTING ILLNESS AND LIVING WITH ILL HEALTH

Rutland PCT Cluster

There are a number of causes that increases the risk of cervical cancer development,
these factors include, age, genetics, smoking, HIV, oral contraceptives and most of all, Highrisk human papillomavirus (HPV) infection. There are more than 100 viruses within the HVP
group, of those around 40 types of HPV infections have an effect on ones genital area.
These viruses affect ones skin and moist membranes in our mouths, cervix, throat and anus
and is transmitted through any sexual activity, including oral and anal sex. The virus has the
ability to cause abnormal tissue growth for example in the cervix that has the possibility to
lead to cervical cancer.
As part of the NHS childhood vaccine programme as seen in Figure 2, all girls in year 8
(age 12-13) are offered the vaccine. The NHS believes that just by vaccination, over 400 live
could be saved yearly from cervical cancer. They also believe that in conjunction with the
vaccinations and regular cervical screening (every 3 years) 70% of cervical cancer cases
could be avoided.
Cervical Screenings is so important due to the limited presentable symptoms of cervical
cancer. Some early symptoms of abnormal cell growth and cervical cancer can include,
vaginal bleeding, painful and uncomfortable intercourse and foul smelling vaginal discharge.
However, if these abnormal cells are left untreated and one disregards cervical screening,
this could lead to growths that could lead to cervical cancer. Advance cervical cancer has the
ability to spread out of the cervix into any of the surrounding tissues and organs. If the
cancer starts spreading, more noticeable symptoms might include; bone pain, haematuria
(blood in the urine), constipation, weight loss and even hydronephrosis (severe pain caused
by swollen kidneys).
Should one be diagnosed with cervical cancer the treatments options will be based on
the stage of the cancer. The NHS has a 4 stage cancer scale for cervical cancer:

stage 0 pre-cancer (not cancer as yet) cells have been detected this is called
cervical intraepithelial neoplasia (CIN) or carcinoma in situ (CIS), these are also
listed in stages and can be easily treated and monitored or managed

stage 1 contained within the cervix

stage 2 cancer spread to outside the cervix and the surrounding tissue,
although the cancer has not extended to the tissue lining the pelvic wall or the
lower part of the vagina

tage 3 spread into the pelvic wall and/or lower section of the vagina

stage 4 spread into the bowel, bladder or other organs, such as the lungs
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MONIQUE MAVRONICOLAS PREVENTING ILLNESS AND LIVING WITH ILL HEALTH

A multidisciplinary team (MDTs) will recommend in the majority of cases that in the event
of early cervical cancer that one have one of three possible options of surgery depending the
spread of the cancer (radical trachelectomy, hysterectomy or pelvic exentertion) or have
radiotherapy, however in some cases a combination of the 2 might be suggested. In
advanced cervical cancer either radiotherapy or chemotherapy or an amalgamation of the
two, often surgery might also be added if possible to remove some growths.
Cervical cancer is survivable in early detection, hence the importance of cervical
screenings, Figure 2 reflects a one year survival chart within the different stages of the
cancer.
Figure 2 Cervical Cancer (C53): 2006-2010 - One-Year Relative Survival (%) by
Stage, Adults Aged 15-99, Former Anglia Cancer Network
(http://info.cancerresearchuk.org/cancerstats/faqs/#How)

Relative survival can be greater than 100% because it accounts for background
mortality. A relative survival figure greater than 100 indicates that people diagnosed have a
better chance of surviving one (five) year(s) after diagnosis than the general population.
Lifestyle changes could have positive effects on living with cervical cancer depends on
the diagnosis and the treatment plan. Treatment may remove and destroy all the cancer for
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MONIQUE MAVRONICOLAS PREVENTING ILLNESS AND LIVING WITH ILL HEALTH

some woman, and life will continue as normal, but for others the cancer might never go
away. In either of these cases one should look at healthy life changes by means of quitting
smoking, eating well (plenty of fresh fruit and vegetables with a higher intake of fibre foods,
minimising animal fats, red meats, salt and smoked or pickled foods), have a regular low
impact exercise programme, try and stick to sensible alcohol drinking guidelines and try and
have as many alcohol free days as possible and last but not least, emotional support.
Depending on the treatment one has had or having on a continuous basis, it could affect
how one feels. Apart from coping emotionally, one could have ongoing side effects that could
have an additional impact on ones emotional state of well-being. Talk to friends and family,
speak to health professionals if you have questions, join a support group, read every
possible survival story you can find, as hope is as much as part of recovery as all the other
things.
4. Conclusion
Over the years there have been accumulative acknowledgement in the way disease is
treated and managed and often that responses were too late. The aim of the NHS is to
engage people more in their personal health and well-being and prolong their lives be
preventing illness rather than curing. The British journal of cancer reported in December
2013 that nearly half of all cancers diagnosed in the UK every year is attributed by avoidable
life choices such as smoking, not eating enough fresh fruit and vegetables, being overweight
and other environmental factors. Professor Max Parkin, the lead author of the report stated:
Looking at all the evidence, its clear that around 40% of all cancers are caused by things we
mostly have the power to change. (http://www.healthiq.co.uk/component/k2/item/159prevention-is-better-than-cure.html). The concept of preventing illness is just like the old
proverb used by Henry de Bracton An ounce of prevention is worth a pound of cure and
with more prevention comes less need for cure.
5. References
Disease vs Illness available at - http://www.bboyscience.com/disease-vs-illness/
accessed on 10 December 2014
Preventing Illness available at http://www.sciencemuseum.org.uk/broughttolife/themes/treatments/preventing.aspx
accessed on 10 December 2014
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MONIQUE MAVRONICOLAS PREVENTING ILLNESS AND LIVING WITH ILL HEALTH

Stages of prevention available at - http://phprimer.afmc.ca/Part1TheoryThinkingAboutHealth/Chapter4BasicConceptsInPreventionSurveillanceAndHealthPro

motion/Thestagesofprevention accessed on 10 December 2014
Primary prevention available at http://www.kingsfund.org.uk/projects/gpcommissioning/ten-priorities-for-commissioners/primary-prevention - accessed on 10
December 2014
Prevention and Reduction: A review of strategies for intervening early to prevent or
reduce youth crime and anti-social behaviour available at
http://www.natcen.ac.uk/media/25254/prevention-reduction-review-strategies.pdf - accessed
11 December 2014
Call to Action: Commissioning for Prevention available at http://www.england.nhs.uk/wpcontent/uploads/2013/11/call-to-action-com-prev.pdf accessed 11 December 2014
Preventative medicine, integrative medicine & the health of the public available at
http://www.iom.edu/~/media/Files/Activity%20Files/Quality/IntegrativeMed/Preventive
%20Medicine%20Integrative%20Medicine%20and%20the%20Health%20of%20the
%20Public.pdf accessed on 11 December 2014
Preventative Healthcare available at http://en.wikipedia.org/wiki/Preventive_healthcare
accessed on 11 December 2014
Levels of Medical Care: Primary, Secondary, Tertiary and Quaternary Care available at http://patients.about.com/od/moreprovidersbeyonddocs/a/Stages-Of-Care-PrimarySecondary-Tertiary-And-Quaternary-Care.htm - accessed on 12 December 2014
Primary, Secondary, and Tertiary Prevention: Important in Certification and Practice
available at - www.fhea.com/CertificationCols/level_prevention.htm accessed on 12
December 2014
Cervical Cancer Statistics available at http://www.cancerresearchuk.org/cancerinfo/cancerstats/types/cervix/ accessed on 12 December 2014
Cervical cancer vaccine available at http://www.nhs.uk/Conditions/vaccinations/Pages/hpvhuman-papillomavirus-vaccine.aspx accessed on 12 December 2014

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MONIQUE MAVRONICOLAS PREVENTING ILLNESS AND LIVING WITH ILL HEALTH

No Excuses available at http://www.noexcuses-nhs.co.uk/ accessed on 12 December

2014
Cervical Screening Awareness Week available at http://www.jostrust.org.uk/getinvolved/campaign/cervical-screening-awareness-week accessed on 12 December 2014
Time-to-test Campaign available at http://time-to-test.com/ accessed on 12 Dcember
2014
NoFearGoSmear campaign available at http://www.itv.com/thismorning/health/no-feargo-smear-cervical-cancer-screening-campaign accessed on 12 December 2014

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