Abstract

The high-risk approach to disease prevention consists of targeting preventive interventions to those groups of individuals with an increased risk of chronic disease, such as cardiovascular disease, diabetes, cancer, respiratory disease, depression and musculoskeletal disease. Risk groups are defined on the basis of factors that are known to increase the risk of developing a variety of chronic diseases. These common factors are: advanced age, female gender, non-Western origin, low educational level, family history, overweight, smoking, unhealthy diet (including use of alcohol), physical inactivity, loneliness, poor physical design of neighborhood/district, low social cohesion, living alone and the loss/death of a partner.
Providing preventive services to groups of people with more than one of these risk factors appears to be a promising strategy in terms of improving the health of individuals in a specific risk group and lowering their risk of chronic disease. Such preventative measures can target the individual and his/her surroundings/environment. Chronic diseases mostly occur among the elderly population. However, preventive interventions should be implemented at earlier life-course stages to provide the maximum benefit. The most appropriate life-course stage for interventions varies with the risk factor under consideration. This can be concluded from a study conducted by the National Institute for Public Health and the Environment (RIVM) commissioned by the Dutch Ministry of Health, Welfare and Sport (VWS).
The study also shows that the effectiveness of most of these interventions has not yet been fully determined. Only eleven of the interventions listed in this report are known to be (cost-)effective over the short term. Studies on the degree of participation and uptake of the interventions among high-risk groups and on long-term health benefits are needed to estimate the impact of high-risk preventive approaches on public health.