Page 167 - The Handbook of Persuasion and Social Marketing

Social Marketing as Social Control 159

the first stage of the public health mission involves the establishment of
surveillance systems; in the case of interpersonal violence, this means col-
lecting data on “who is being hurt and under what circumstances.” The
public health model, then, is utilitarian at heart, because even though step-
ping up surveillance of the population for purposes of monitoring and
(hopefully) eradicating yet another “disease” is potentially harmful or de-
bilitating to some groups, what counts in the end is the greatest good for
the greatest number of people. That is, proponents of the public health
model argue that whatever costs are incurred in the process of defining and
treating violence as a disease are outweighed by the expected future bene-
fits—namely, reducing or eliminating violence.

Three Stages of Prevention

The public health model conceptualizes a tripartite classification of pre-
vention consisting of primary, secondary, and tertiary stages. These three
stages or strategies of prevention are summarized below.

• Tertiary prevention encompasses all those strategies designed to keep persons
who are already ill from becoming sicker. This is the classic “reactive” approach
to social and health problems.
• Secondary prevention involves the early identification of those who already have
symptoms of some disease. At-risk profiles, generated from heightened surveil-
lance of the target population, help to determine which individuals are good
candidates for early intervention. Secondary prevention represents a mix of
reactive and proactive approaches.
• Primary prevention focuses on stopping some problem behavior before it starts,
the overall goal of which is to reduce health problems in the general popula-
tion. Strategies may include educational and public information campaigns;
changing the environment, organization, or institution; immunizing potential
hosts or victims; and so forth. These approaches are characterized as
“proactive.”

A recent addition to this tripartite classification of public health preven-
tion is “quaternary prevention.” Interestingly, this new category recognizes
that many preventive measures in the name of public health or safety can
lead to overmedicalization or medically invasive procedures far out of pro-
portion to the health risks posed by the identified unwanted behaviors or
social conditions. Over time, then, prevention has expanded from a nar-
rower focus on illness to a broader focus on risk factors for a variety of
disfavored conditions that go beyond problems in physical health per se
(Starfield, Hyde, Gérvas, & Heath, 2008).