Introduction

In arguing for increased research funding, attention is often drawn to the finding that schizophrenia accounts for 2.3% of the total burden of disease (disability adjusted life years, DALYs) in established market economies (Murray and Lopez, 1996). How is it that, despite 1.4–2.8% of national health care being devoted to the direct costs of schizophrenia, the burden of disability is still so high? What would the burden of schizophrenia be if funds were unlimited and optimal treatments (medication, psychosocial interventions, service mix, etc.) were delivered consistently? Most commentators would concede that the burden would still be inevitable. In other words, a substantial proportion of the DALYs associated with schizophrenia are ‘unavertable’ in terms of secondary and tertiary prevention. An alternative, and more ambitious, approach to averting DALYs is to reduce the incidence of a disorder. This chapter will discuss issues related to primary prevention in general and then speculate on directions for future research related to schizophrenia.

The science of prevention

In its simplest form, primary prevention aims to reduce the incidence of a disease. Prevention strategies can be directed at different target populations (Gordon, 1983; Mrazek and Haggerty, 1994): (i) universal preventive interventions are aimed at the general population regardless of risk status/susceptibility status; (ii) selective preventive interventions target particular population subgroups, who may be more susceptible to a disorder but who are still symptom free; (iii) indicated prevention is targeted at individuals who have the early features or subclinical manifestations of a disorder.