204 | Noncommunicable Diseases in Saudi Arabia
treatment is desirable from a cost perspective. It is almost always more costly to treat NCDs than to prevent them from developing in the first place or from progressing to more advanced stages (World Bank 2012). Nevertheless, for persons with biological risk factors that screening has detected as being out of the norm and for whom nonpharmacological measures are no longer effective, appropriate treatment will still be needed. Stakeholders agreed that the master plan will focus on both population-level and individual-level prevention of NCDs. Population-level prevention or reduction of risk factors levels and, by implication, promotion of health through interventions across health and nonhealth sectors is a “primordial” approach in the sense that it is a means of “preserving entire risk-factor-free societies from the penetration of risk factor epidemics” (Strasser 1978). In the context of Saudi Arabia, this approach is, for example, applicable to the interventions prohibiting alcohol consumption. Most primordial interventions sit outside the health sector. Individual-level prevention—through detection, referral, and monitoring of the biological risk factors—facilitates early identification and treatment of NCDs and prevention of their complications. This second approach (often referred to as disease control because it seeks to reduce the consequences of developing a disease) is “remedial” and is carried out within the health system (at primary care centers, for example). It aims to reduce risk in persons where it is detected, to increase the survival of persons with NCDs when they do occur, and to improve the function and prognosis for persons living with NCDs. Comprehensively organized prevention activities have to be directed at all levels of prevention (box 9.2). The master plan will deal with primordial prevention, primary prevention (often termed health promotion), and secondary prevention. The main focus and primary targets of the master plan are (1) persons who are healthy and (2) persons who are at risk of developing NCDs because they have one or more lifestyle or biological risk factors. The set of selected interventions will therefore focus on (1) maintaining and preserving good health and (2) preventing persons at risk from developing NCDs. The first version of the
BOX 9.2
Focus on three levels of prevention in the master plan • Primordial prevention (essential health promotion) targets healthy individuals and groups with no current risk factors with health promotion messages that are useful for other population groups as well. • Primary prevention (standard health promotion) targets individuals who are still primarily healthy but are in generational groups that are at risk (for example, children, youth, the elderly). • Secondary prevention (screening) identifies either risk factors or early signs of disease or the presence of disease in its very early stages.
