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IJE Advance Access published online on July 15, 2004
International Journal of Epidemiology, doi:10.1093/ije/dyh232
© 2004 by International Epidemiological Association
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Accepted April 20, 2004

Original paper

When the population approach to prevention puts the health of individuals at risk

Jean Adams 1* Martin White 1

1 School of Population and Health Sciences, Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, NE2 4HH, UK

* To whom correspondence should be addressed. E-mail: j.m.adams{at}ncl.ac.uk.


  Abstract

The population approach to prevention has been described as one of the ‘absolute truths’ of preventive medicine. However, when the relationship between risk factor exposure levels and associated risk is J-shaped the population approach can increase risk in a small number of individuals. There is evidence that the relationship between a variety of exposures and all-cause morbidity and mortality is J-shaped. However, such relationships are often overlooked by epidemiological investigations which focus on cause-specific morbidity and mortality. Although the overall beneficial effect of population interventions may outweigh any negative effect seen, the effect on the individuals concerned should not be overlooked--especially when they can be easily identifiable before the intervention. Procedures, akin to gaining informed consent in clinical situations, may be required to ensure that individuals who are at high risk of being negatively affected by population interventions understand the risks involved and have the opportunity to opt out.

Keywords: Population approach, prevention measures, Geoffrey Rose, J-curves.
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