Public Health Pyramid

Center for Disease Control and Prevention (CDC) director Dr. Tom Frienden has recently published a special article in The New England journal of medicine entitled “The future of public health”. In that article, he discussed about the public health pyramid.

  • Public health pyramid consists of five levels as described in figure 1. At the bottom – the base of the pyramid – there lies the socioeconomic factors, for example income, education, housing etc. These are also known as social determinants of health. In spite of the fact that they are not diseases, disease burden follows the socioeconomic gradient i.e. poor people are more affected by disease and poor health. The impact of any intervention focusing at this level is highest.
  • Immediate above the socioeconomic factors, there are traditional public health interventions such as provision of clean water and sanitation. This level helps to improve the context to make default decision making for healthy choices.
  • At the next level, there are long-lasting protective interventions, i.e. immunization, screening etc. These requires intermittent action by the health care system.
  • Clinical interventions are in the next level which requires individualized long-term care for a specific disease, such as blood pressure control.
  • The top level of this pyramid is counselling and health education. These efforts motivate people to adapt healthy lifestyles such as physical activity, eating healthy foods etc.

Though each level has its own importance in reducing the disease burden, interventions aiming at the base of the pyramid has larger impact on health, usually at lower cost. Alongside, to improve the impact of clinical care on population health, focus on the third and fourth levels are of great importance.

Link to the article:


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