STRENGTHENING RISK PREVENTION POLICIES CHOOSING PRIORITY STRATEGIES FOR RISK PREVENTION constructing health policies for the prevention of well-known risks, choices need to be made between different strategies. For instance, will preventing small risks in large opulations avoid more adverse health outcomes than avoiding large risks in a smaller number of high-risk individuals? What priority should be given to cost-effective interventions for primary rather than secondary prevention, such as lowering blood pressure distribution by reducing dietary salt intake compared with treatment of people with high blood pressure Should priority be given to preventing environmental and distal risks to health, such tackling poor sanitation or inadequate nutritional intakes, rather than the more obvious proximal risks in a causal chain? What is the most appropriate and effective mix of these strateges In practice there is rarely an obvious and clear choice. These strategies are usually combined so as to complement each other (1). In general, however, it is more effective to give prority to population-based interventions rather than those aimed at high-risk individuals primary over secondary prevention controlling distal rather than proximal risks to health POPULATION-BASED INTERVENTIONS OR HIGH-RISK INDIVIDUAL TARGETS? 3 There is a"prevention paradox which shows that interventions can achieve large overall alth gains for whole populations but might offer only small advantages to each individual. This leads to a misperception of the benefits of preventive advice and services by peop who are apparently in good health (2, 3). In general, population-wide interventions have the greatest potential for prevention. For instance, in reducing risks from blood pressure and cholesterol, shifting the mean of whole populations will be more cost-effective in avoiding future heart attacks and strokes than screening programmes that aim to identify and treat all those people with defined hypertension or raised cholesterol levels, as show in Figure 6.1 (4-6). A similar approach can be used to modify behavioural risks and envi- ronmental exposures. For example, lowering the population mean for alcohol consump tion will also predictably reduce the number of people suffering from alcohol abuse(7 Often both approaches are used and successfully combined in one strategyStrengthening Risk Prevention Policies 147 6 STRENGTHENING RISK PREVENTION POLICIES CHOOSING PRIORITY STRATEGIES FOR RISK PREVENTION  n constructing health policies for the prevention of well-known risks, choices need to be made between different strategies. For instance, will preventing small risks in large populations avoid more adverse health outcomes than avoiding large risks in a smaller number of high-risk individuals? What priority should be given to cost-effective interventions for primary rather than secondary prevention, such as lowering blood pressure distribution by reducing dietary salt intake compared with treatment of people with high blood pressure? Should priority be given to preventing environmental and distal risks to health, such as tackling poor sanitation or inadequate nutritional intakes, rather than the more obvious proximal risks in a causal chain? What is the most appropriate and effective mix of these strategies? In practice there is rarely an obvious and clear choice. These strategies are usually combined so as to complement each other (1). In general, however, it is more effective to give priority to: • population-based interventions rather than those aimed at high-risk individuals; • primary over secondary prevention; • controlling distal rather than proximal risks to health. POPULATION-BASED INTERVENTIONS OR HIGH-RISK INDIVIDUAL TARGETS? There is a “prevention paradox” which shows that interventions can achieve large overall health gains for whole populations but might offer only small advantages to each individual. This leads to a misperception of the benefits of preventive advice and services by people who are apparently in good health (2, 3). In general, population-wide interventions have the greatest potential for prevention. For instance, in reducing risks from blood pressure and cholesterol, shifting the mean of whole populations will be more cost-effective in avoiding future heart attacks and strokes than screening programmes that aim to identify and treat all those people with defined hypertension or raised cholesterol levels, as shown in Figure 6.1 (4–6). A similar approach can be used to modify behavioural risks and envi￾ronmental exposures. For example, lowering the population mean for alcohol consump￾tion will also predictably reduce the number of people suffering from alcohol abuse (7). Often both approaches are used and successfully combined in one strategy