EPHO5: Disease prevention, including early detection of illness

The purpose of this essential public health operation (EPHO) is to prevent disease through actions at primary, secondary and tertiary levels. Most of these actions fall within the role of health professionals and health care providers in primary care, hospitals and community services environment.

There are three levels of prevention:

  1. improving the overall health of the population (primary prevention)
  2. improving (secondary prevention)
  3. improving treatment and recovery (tertiary prevention).

Each of the three approaches has an important role to play in disease prevention. However, upstream approaches, e.g. primary prevention, generally tend to be cheaper and more efficient, and they entail lower morbidity and mortality rates. Health promotion (EPHO 4) is inextricably intertwined with disease prevention.

A recent self-assessment of public health services in 41 of the 53 countries in the WHO European Region found that:

  • Primary prevention: routine immunization programmes are established in some form in all countries, and in most cases are well developed and effective. However, arrangements for delivery of vaccine programmes are under-developed in some countries, especially for minority populations. Some Commonwealth of Independent States have seen an increase in vaccine preventable diseases following the breakdown of services available in the Soviet era.
  • Secondary prevention: routine screening for major forms of cancer now exists in many countries, but not in all of them. Screening programmes are not always evidence-based and systemic health checks for noncommunicable diseases are not routine in most countries.
  • Tertiary prevention: lack of availability and affordability of treatment for early stage cancers is a limiting factor in some countries. Staff need training in evidence-based treatment and management approaches for noncommunicable diseases, and modern equipment.

As a result, a recommendation was made to ensure a balance in the three disease prevention approaches: primary (vaccination and health promotion), secondary (screening and early detection of disease) and tertiary (integrated patient-centred disease management).

Vaccine-preventable diseases and immunization

WHO/Europe provides policy and technical assistance to countries to maximize equitable access of all people to vaccines of assured quality as part of the Global Immunization Vision and Strategy (GIVS).

Primary health care

WHO/Europe has supported 10 countries to conduct studies on organization and provision of primary care services. It provides data to facilitate international comparisons on performance in primary care services.

Mental heath and mental disorders

Since 2008, WHO/Europe is partnering with the European Commission to run a project to empower users of mental health services and their families.

Cardiovascular diseases, cancers, chronic respiratory diseases and diabetes

WHO supports countries with surveillance of diseases, risk factors and enhancing early detection of diseases.


WHO/Europe supports a health system approach in tackling the HIV epidemic. It has developed an action plan for 2012 to 2015 keeping with the 2001 United Nations Declaration of Commitment on HIV/AIDS.

Sexually transmitted infections (STI)

WHO/Europe is combating STIs throughcollaborations with the International Union against STIs and the United Nations Children’s Fund (UNICEF).


WHO/Europe supports countries in implementation of the Stop TB Strategy, and together with its partners is developing a consolidated action plan to prevent and combat M/XDR-TB in Europe.