High-Risk Versus Population Prevention Strategies for NCDs: Geoffrey Rose Revisited in the Twenty-First Century

Some 25 years ago, Geoffrey Rose, the eminent British epidemiologist, enunciated fundamental principles of chronic disease prevention, focused at that time on cardiovascular disease, in his landmark paper “Sick Individuals and Sick Populations” (Rose, Int J Epidemiol 14:32–38, 1985).

This chapter contends that the timeless insights in that paper have been repeatedly ignored in the intervening decades in chronic disease prevention, despite much scientific advance, and investment internationally. It reviews the key arguments of Rose, explaining their relevance to current preventive policy dilemmas and opportunities, through the use of modern examples of chronic disease prevention controversies.

It concludes by describing some common underlying values and beliefs, and some powerful vested interests in modern society, that perennially undermine evidence-based policy in this field. This occurs through the persistent prioritization of individually based, medicalized risk factor screening and management programs to prevent chronic disease, leaving unexploited the immense potential of primary—indeed, “primordial”—preventive policies to alter “lifestyles,” by incentivizing healthy behavioral changes throughout the life-course.