Prevention toolkit

Tool 1 – Scottish Government Prevention Unit Prevention Definition

What is the Tool?

• This Scottish Government Prevention Unit definition of prevention provides a standard framework for defining whether an activity is preventative, and at what “level” of prevention (primary, secondary, tertiary).

Use this to

• Develop a consistent categorisation of activities that is consistent with the wider prevention definition used in Scotland.

You end up with…

• A clear sense of whether your activity is considered “preventative” in the Prevention Unit definition, and at what level of prevention.
• If your activity isn’t classified as prevention (e.g. responsive activity), the tool supports the framing of how your activity can still contribute to a preventative system.

Who can use this?

• The Prevention Unit definition is relevant for anyone looking to understand prevention across the full public sector, business, community and voluntary sector looking to understand prevention.

How does this tool support prevention thinking?

• Defining prevention is the first step in developing and analysing preventative policy. It is fundamental to the use the other tools in this Toolkit.

Using the tool

The Scottish Government Prevention Unit Definition

The Prevention Unit definition of prevention includes an overarching definition of prevention, and different levels of prevention (Figure 1).

The definition has been designed to build on existing definitions used in Scotland and other jurisdictions, with a focus on meaningfully categorising and measuring different types of prevention activity.

Figure 1 - Scottish Government Prevention Unit prevention definition

Prevention Definition

The Scottish Government Prevention Unit defines prevention as: activity intended to stop the establishment, escalation or recurrence of problems that lead to negative outcomes for people.

Levels of Prevention

Primary Prevention: Population-level action, or action which targets a large subset of the population, to build resilience and stop known risks from developing into problems

Secondary Prevention: Targeted action to identify and respond to early signs of a problem to prevent escalation

Tertiary Prevention: intervention once there is a problem to stop it from getting worse or recurring in future

Applying the Definition

Step 1: Specify the prevention activity

Before applying a prevention definition, it is useful to try and be as specific as possible about your activities. If an activity/ programme is too aggregate, this will make it difficult to distinguish between what may be preventative vs other types of activity.

For example, defining “the justice system” as preventative is too broad to allow for meaningful categorisation and analysis, particularly in terms of defining at what prevention levels the activity sits. However, defining activities within this, such as programmes to prevent first time offenders, or reoffending, allows a much easier categorisation.

Step 2: Understand the primary purpose and target population of the activity

Once the activity has been specified, there are two guides that can help assess whether the activity is preventative, and what level of prevention it is (if preventative). These are:

• The target population – the target population is often sufficient as a guide on the level of prevention for a particular activity. For example, whether the intervention is population level (which tends to be primary prevention), a smaller sub-set of the population at risk (secondary), or a targeted group who have experienced a problem (tertiary).
• Primary purpose of the policy – we also consider the primary purpose of the policy and whether it aims to stop something happening in the first place (primary), stop the emergence of problems for at-risk groups (secondary), or stop something from getting worse (tertiary).

Step 3 – Apply Prevention Classification

Figure 2 shows examples of categorisation of activities between preventative and other types of activity.

Figure 2 – Activity type classification and examples

Activity type: Preventative

Target Population: Activity directly targets either the whole population or a subset of the population who are not currently experiencing harm or crisis

Primary purpose: Activity primarily aims to stop a problem happening, escalating or getting worse once it has happened.

Examples:

• Immunisations
• Healthy eating programmes
• Parental Employability Support Fund
• 20 mph speed limits
• Rehabilitating ex-offenders

Activity type: Responsive

Target Population: Activity primarily targets specific individuals or groups in crisis or needing immediate support

Primary purpose: Activity primarily aims to respond to an immediate need, crisis, event or harm

Examples:

• Emergency hospital care
• Crime response
• Fire response
• Children in secure care

Figure 3 shows how these assessments of target population and main purpose can then be used to make an assessment of the level of prevention.

Figure 3 – Examples of prevention at different levels

Level: Primary prevention

Target Population: Targeted at the population-level, either tackling the population overall or a large subset of the population (e.g. all children).

Primary purpose: Targets a problem before an identifiable need emerges.

Examples:

• Vaccines
• Police community outreach
• Workplace health and safety

Level: Secondary prevention

Target Population: Targets a specific or defined group at risk.

Primary purpose: Targets a problem that has started to emerge, to stop it from escalating.

Examples:

• Cancer screenings for at-risk groups
• Pupil Equity Funding to close income-related attainment gap

Level: Tertiary prevention

Target Population: Targets a specific group of people who were at risk and required an acute intervention.

Primary purpose: Targets a problem that has emerged but tries to prevent getting worse.

Examples:

• Diabetes management
• Rehabilitation for ex-offenders

Step 4 – Reviewing against available evidence

Defining an activity is the first step in analysing a prevention activity. Next, it is typically useful to consider what outcomes will be impacted by the preventative activity, and what evidence exists on the effectiveness of the activity.

Over the longer term, evidence to appraise and evaluate the preventative impacts of policies should be undertaken. Based on this evidence, you should review your preventative activities to understand the extent to which the policy is actually achieving the prevention it is intending to.

Where to find more information/ support

More information on how the Scottish Government Prevention Unit defines prevention can be found in the Defining Prevention publication.

Other resources

Examples of similar prevention definitions used in Scotland:

• Public Health Scotland Prevention Definition
• Scotland’s Population Health Framework
• Equally Safe 2023 Strategy
• Learning from 25 years of Preventative Interventions in Scotland

Similar prevention definition frameworks in other jurisdictions:

• Kings Fund
• Chartered Institute for Public Finance and Accounting
• Welsh Future Generations Commissioner
• World Health Organisation
• Herriot-Watt homelessness prevention definition

Mapping Preventative Systems

Prevention in public policy is a complex topic. A particular driver of preventable demand or outcomes can potentially have many causes and many effects.

This makes understanding the complexity a challenge.

Tools for mapping preventative systems help to analyse their complexity. They help us understandwhat the drivers of preventable demand are in a system, and how these drivers impact on outcomes for people and public services. They can also highlight the key protective/ risk factors to target to reduce demand in future.