A cause without an effect? Primary prevention and causation

Clinical primary prevention eliminates or preempts either a susceptibility or risk (synergistically a cause) in order to avoid a specific harm. Philosophically, primary prevention gets caught in the metaphysical controversy of the "hard questions" of whether it is possible to "cause not" both through a positive action (preventive act causes no harm) or no action (avoiding something causes no harm). I examine my previously proposed four-step definition of the process of prevention, discuss its limitations in light of the "hard questions," and then offer a revised five-step process definition that eliminates the "cause not" concerns by changing the goal of prevention from avoiding harm, a negative state, to achieving optimal health, a positive state.