Preventive Healthcare - World Health Systems Facts

“Prevention as a key aspect of healthcare is probably as old as history. Asclepius and Hippocrates in Ancient Greece focused medical care on the congruence between the person and their environment, with a special emphasis on physical exercise.² In 2008, the World Health Organization reported that approximately 80% of cases of heart disease, stroke and type 2 diabetes mellitus could be prevented globally by addressing smoking, physical inactivity and unhealthy diets.³“

Source: Margolis SA. Preventive healthcare: A core component of Australian general practice. Aust J Gen Pract. 2018;47(12):821. doi:10.31128/AJGP-11-18-4751

“Preventive services are critical for maintaining optimal health and well-being throughout the lifespan. Preventive services, such as screenings, preventive medicines, and counseling, facilitate the prevention or early detection of health issues. Early detection can lead to early intervention and better treatment outcomes, often preventing the progression of diseases and reducing the risk of disease complications.⁸^,⁹ Combining these types of preventive services with a healthy lifestyle can substantially reduce the risk for diseases, disabilities, and death.⁸^,⁹“

Source: Nicholson WK, Silverstein M, Wong J. 14th Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services: Commemorating 40 Years of Making Evidence-Based Recommendations for Preventive Services [Internet]. Rockville (MD): U.S. Preventive Services Task Force (USPSTF); 2024 Nov.

“Clinical preventive services are available for many diseases and conditions, including strategies that intervene before a disease occurs (primary prevention) and detecting a disease at an early stage (secondary prevention) for early intervention and treatment.³^,⁴ These clinical preventive services have tremendous value in improving health throughout the lifespan.”

“Avoidable mortality includes both preventable deaths that can be avoided through effective public health and prevention interventions, and treatable deaths that can be avoided through timely and effective healthcare interventions. COVID-19 is categorised as a preventable disease in the “infectious diseases” category, on the basis that most deaths could be prevented through measures such as vaccination and the use of protective equipment.

“Across 26 OECD countries with available data for 2020 or 2021, over 3 million premature deaths among people aged under 75 years could have been avoided through better prevention and healthcare interventions. This amounts to almost one-third of all deaths. Of these, about 2.1 million were considered preventable through effective primary prevention and other public health measures, and almost 1 million were considered treatable through more effective and timely healthcare interventions.

“Infectious diseases were the main cause of preventable mortality in 2021 (22% of all preventable deaths). Noting that this category only accounted for 2% of preventable deaths in 2019, the increase is strongly associated with COVID-19. Some cancers that are preventable through public health measures were also among the main causes of preventable mortality in 2021. Other major causes were injuries, such as road accidents and suicide (17%); heart attack, stroke and other circulatory diseases (16%); alcohol and drug-related deaths (13%); and some respiratory diseases such as influenza and COPD (6%) (Figure 3.7).

“The main treatable cause of mortality in 2021 was circulatory diseases (mainly heart attack and stroke), which accounted for 37% of premature deaths amenable to treatment. Effective, timely treatment for cancer, such as colorectal and breast cancers, could have averted a further 23% of all deaths from treatable causes. Respiratory diseases such as pneumonia and asthma (11%), as well as diabetes and other diseases of the endocrine system (10%) are other major causes of premature death that are amenable to treatment (Figure 3.7).”

Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.

“The effect of making routine childhood immunisation (ie, regular and ongoing immunisation services, often delivered during routine health visits) widely available has been drastic, resulting in an estimated 154 million deaths averted globally between 1974 and 2024, with nearly 95% of those in children younger than 5 years.³

“Although delivering routine childhood vaccinations worldwide requires a tremendous investment of global resources, including approximately US$3·9 billion in development assistance for health in 2023,⁴ childhood immunisation has proven to be one of the most successful and cost-effective public health strategies known, both in terms of lives saved and return on investment.^5,6 Estimates have shown the financial rate of return to be in some instances up to 44-times the cost of vaccination.⁷ Yet the remarkable successes of EPI [Essential Program on Immunization] have slowed in the past decade and in some cases reversed, suggesting weaknesses in health services that were further exposed during the global upheaval caused by the COVID-19 pandemic, including social distancing measures, health system diversions, and supply chain disruptions. Previous estimates suggest that coverage with the third dose of the diphtheria, tetanus, and pertussis vaccine (DTP3) decreased in 94 countries and territories between 2010 and 2019, and only 11 countries worldwide were estimated to have reached the 2019 target set by the WHO Global Vaccine Action Plan of at least 90% coverage for all assessed vaccines.⁸ As coverage has stalled, new and increased outbreaks of vaccine-preventable illness, such as measles, polio, and diphtheria, have emerged in many countries and territories.⁹“

Source: GBD 2023 Vaccine Coverage Collaborators. Global, regional, and national trends in routine childhood vaccination coverage from 1980 to 2023 with forecasts to 2030: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet. 24 June 2025. doi: 10.1016/S0140-6736(25)01037-2.

“Although some of the COVID-19 pandemic-specific challenges to vaccination have receded, several key challenges persist—including increasing disparities in resource-constrained, conflict-affected, or politically-volatile countries and territories;^79,80 intensification of migration and displacement; and climate-related crises.^10,11 An additional challenge to progress has been the threat of growing vaccine hesitancy. Deriving from many complex origins, vaccine misinformation^81,82 and scepticism were already challenges before the pandemic, identified by WHO in 2019 as one of the ten leading threats to global health.^23,83,84 The COVID-19 pandemic, which in many areas bred declining trust in public health institutions⁸⁵ and polarised opinions about the necessity and safety of vaccination against COVID-19,⁸² has had varying effects on public perceptions regarding the importance of routine childhood vaccination and willingness to vaccinate. A 2023 global analysis reported that vaccine hesitancy prevalence ranged from a low of 13·3% in the WHO region of the Americas to a high of 27·9% in the Eastern Mediterranean region,⁸⁶ and even higher in select African countries.⁸⁷ In the USA, most parents remained convinced of the benefits and effectiveness of childhood vaccines between 2020 and 2022, with confidence levels ranging from 89·5% to 92·5%, although concerns about vaccine safety and side-effects increased over that time,⁸⁸ and kindergarten vaccine exemption rates in 2023–24 were the highest ever reported.⁸⁹

“Although overall confidence in routine childhood immunisation remains relatively high, the COVID-19 pandemic clearly exposed a vein of public distrust regarding health policy that is likely to influence public perception of childhood vaccines into the future.⁸⁴ Strategies to improve vaccine confidence include bolstering scientific literacy to protect against an erosion of trust in science, implementing targeted public health campaigns to promote routine childhood immunisation, including community input in scientific research and policy making, engaging with community and religious leaders as advocates for immunisation, and elevating and equipping health-care providers—who remain the most trusted voices on vaccination—to have impactful conversations about decisions to immunise.^25,83,84“

“This research proposes the hypothesis that an ageing society could place increasing demand on preventive and curative health care. The theoretical model endeavors to reveal the relevant real-world factors at a macroeconomic level to examine this hypothesis. However, a model still has restrictions and might not take all realities into account. The limitation in our study is that we regarded the households as relatively homogenous and the population faced the same risk of ill-health. With data collected from before 2019 when ill health mainly resulted from chronic diseases, these assumptions could be in line with reality. Namely, experiences of chronic disease prevention in OECD countries provide support for the theoretical analysis. However, when the new pandemic infectious disease of COVID-19 occurred after 2020, a more complex model would be needed to accommodate for transmission dynamics and mortality in the elderly.

“Developing and developed economies have witnessed unprecedented growth in the ageing/aged population. However, as the number of elderly people has rapidly expanded, more medical expenditures have been spent, affecting economic growth. Thus, enhancement in productivity by keeping the workforce as healthy as possible is of vital importance. In our analysis, we applied the growth model and treated a society’s adequate investment in prevention as a strategy for maintaining the economy’s productivity in an ageing economy. With limited medical resources, preventive and curative health care may be substitutes for each other financially but are complements in terms of health promotion and maintenance. This study shows that appropriate prevention is associated with decreases in the prevalence rates of ill health, which in turn attains sustainable growth in productivity. Excess prevention, however, could lead to higher detection of new chronic diseases with mild severity, which would result in longer disease duration and higher prevalence rates of ill health. The U-shape relationship between prevention provision and the population’s health status, presented by the prevalence rates of ill health, does exist. With suitable allocation of medical resources, the economic growth rate will help to cancel out increases in healthcare spending for the elderly and for expenses needed for the improvement of the population’s health as a whole. Analytical results from the study also offer alternative scenarios for proactive measures that can be used to assess the effectiveness of other kinds of health intervention. This research assumes that prevention expenditure is funded by the government. In real life, individual people also partially contribute to their own expenditure on health prevention. Fortunately, most OECD countries adopt a universal health coverage system and the government budgets are reasonable. Future research could begin with extensions on agencies that could be allowed to invest in health capital in order to take control of their own prevention health expenditure. Health capital could also depreciate over time and different illnesses have different prevalence rates and hence prevention strategies vary. Models must adopt specific protective measures to avoid transmission such as wearing masks, social distancing and washing hands if pandemic infectious diseases occur.”

Source: Wang, F., Wang, JD. Investing preventive care and economic development in ageing societies: empirical evidences from OECD countries. Health Econ Rev 11, 18 (2021). https://doi.org/10.1186/s13561-021-00321-3

“In response to the call for a person-centered care approach that addresses social determinants, social prescribing has received recent attention. The practice of social prescribing, based on the biopsychosocial model of health and illness, attends to all domains of health including physical, psychological, and social well-being. While there is no consistent, international definition of social prescribing, a common definition given by the Kings’ Fund is “social prescribing, also sometimes known as community referral, is a means of enabling health professionals to refer people to a range of local, non-clinical services care” (The King‘s Fund, 2020). Others have refined this definition to differentiate social prescribing as “a mechanism for linking patients with nonmedical sources of support within the community” [13]. Ultimately, the goal of social prescribing is to help people with a variety of social, emotional, lifestyle-related or practical issues. Social prescribing can be also seen as a facilitator for self-determination, intended as a person’s ability to make their own choices concerning their health and wellbeing. Many programmes are geared toward enhancing mental and physical welfare (The King‘s Fund, 2020). If implemented correctly, social prescribing could potentially deliver cost savings by reducing the utilization of primary care while improving patient health and well-being [14,15]. In addition, as the main characteristic of social prescribing is to connect patients to programmes that are often already accessible in their communities, there is a potential to make a difference at rather low cost. Indeed, numerous studies have assessed the social prescribing model’s cost-effectiveness and provided evidence of long-term savings [[16], [17], [18]]. In 2023, the National Academy for Social Prescribing (NASP) has released 13 evidence publications affirming that social prescribing holds the potential to reduce costs and alleviate pressure within the healthcare system [19].

“Other studies have assessed the effects of social prescribing on patient outcomes. Research has indicated that social prescribing may enhance psychological health, lessen anxiety, and raise the perceived quality of life [20]. However, this evidence is highly context-specific.

“While the definition of social prescribing is still evolving, it is generally thought of as a process within a healthcare system that uses a formal pathway to refer patients to locally available resources, though different models exist. Some social prescribing schemes use a link worker (also known as community navigator) who works together with health professionals to refer individuals to local sources of support while other schemes use general practitioners for referrals. Social prescribing schemes can address various needs, including healthy behavior promotion, social support, and economic needs through connections to programs or activities offered by government agencies, volunteer or community sectors. This may include a referral to a housing program or to activity groups that include for example art making (substantial evidence shows that arts can improve wellbeing, WHO, 2019), garden and culinary activities, group learning, healthy eating guidance, and a variety of sports (Fig. 1).”

Source: Scarpetti G, Shadowen H, Williams GA, et al. A comparison of social prescribing approaches across twelve high-income countries. Health Policy. Published online January 21, 2024. doi:10.1016/j.healthpol.2024.104992

“The scale of implementation of social prescribing across the twelve countries varies significantly. It ranges from pilots (e.g., Australia, Austria, Canada, Finland, Portugal, the Slovak Republic, the US) to initiatives implemented in many municipalities across the territory (e.g., Germany, the Netherlands), to a wider country-wide roll-out (e.g., England, Slovenia, Wales, the US). Countries are also looking at how to understand the place of social prescribing in policy, for example an ongoing feasibility study of non-clinical prescribing n Australia being conducted for the Commonwealth government.

“In general, the needs that can be addressed by social prescribing range from structural determinants (food, housing), psycho-social support networks (eg. bereavement groups, patients’ self-help organisations), health promotion (e.g., walking), and social and recreational supports. Although most countries include programs for social support, these services are uncommon in US social prescribing schemes. Services that individuals can be referred to in all countries include those in almost every sector, including government programs, voluntary, community and social enterprise groups (see Fig. 1), although services can vary between local areas.

“Overall, social prescribing programs have been considered appropriate for individuals with a wide range of conditions, but each specific program usually involves a targeted population. In Canada, England, the US, and the Slovak Republic, social prescribing can be used for individuals with various attributes or needs (e.g., with long-term conditions; mental health issues; lonely or isolated). One example of such programmes is GreenSpace in Nottingham and Nottinghamshire (UK), which aims at improving people’s mental health through nature-based activities and green groups, projects, and schemes. People are usually referred by a link worker based at a GP practice or another primary care professional. The programme is available to everyone. It will offer specific initiatives to support some of the most underserved groups that have been disproportionately impacted by the coronavirus crisis, including people with long-term conditions, particularly older people, Black, Asian, and Minority Ethnic (BAME) communities, and those without access to gardens, balconies, or green space. [22]”

“Improving the engagement of patients with type 2 diabetes and cardiovascular disease (CVD) in their own health and health care can enhance self-management skills and self-efficacy for behavior change, potentially reducing treatment burden. It remains unclear, however, whether US physician practices with more extensive adoption of patient-engagement strategies, including shared decision making, motivational interviewing, and shared medical appointments, have lower potentially preventable utilization and total spending for adults with type 2 diabetes and/or CVD. In a national study of US physician practices and Medicare beneficiaries, we find that practice adoption of patient-engagement strategies is associated with total spending in a nonlinear fashion. Compared with practices with moderate adoption of patient-engagement strategies, practices with high adoption had higher total spending ($25,991 vs $26,364; P < .05) driven by spending for long-term services and supports, while practices with low adoption had higher total spending ($25,991 vs $26,481; P < .01) driven by tests, acute care, and clinical access spending. The results highlight that key stakeholders encouraging the use of patient-engagement strategies should not necessarily expect reduced spending.”

Source: Hector P Rodriguez, Karl Rubio, Chris Miller-Rosales, Andrew J Wood, US practice adoption of patient-engagement strategies and spending for adults with diabetes and cardiovascular disease, Health Affairs Scholar, Volume 1, Issue 1, July 2023, qxad021, doi.org/10.1093/haschl/qxad021

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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other OECD member nations.

Page last updated June 25, 2025 by Doug McVay, Editor.