For proper prevention we need a General Shit Life Reduction Strategy — Part I
In health terms, ‘prevention’ basically means doing stuff that reduces risks to health. Primary prevention focuses on the whole population to stop a problem occurring in the first place, for example through immunisation or discouraging smoking; secondary prevention focuses on at-risk individuals and aims to nip an issue in the bud by detecting and treating it as soon as possible, like we do with screening programmes; and tertiary prevention aims to reduce the impact of an existing condition and maximise a person’s quality of life, for example through rehabilitation and ongoing support to help them manage their condition. These definitions can just as easily be applied to other things like crime, injuries, addiction or violence.
The Government released their Prevention Green Paper in July, to what I might generously call mixed reviews. There is some decent stuff in it but, as usual, it focuses mainly on secondary and tertiary prevention. Most of the criticism was therefore around its failure (once again) to address the root causes of poor health. It briefly mentions some of the wider determinants of health like housing, debt and transport, but doesn’t offer much in the way of action.
We don’t do nearly enough primary prevention. Proper prevention. Politicians tend to focus on policies like increasing access to mental health services (for those who already have poor mental health) or increasing prison numbers (to lock up people who have already committed a crime), but not on changing the social conditions which make mental illness or crime more likely in the first place. Too much focus on fixing problems and not enough on avoiding them, so we spend a bloody fortune just trying to keep a lid on things. It reminds me of the Red Queen in Through the Looking Glass: “it takes all the running you can do, to keep in the same place”.
The problem with prevention
Perhaps one reason why the Green Paper failed to take off was the term ‘prevention’ itself. This pithy article by Sarah Lawson for the New Local Government Network, whose title I nicked for this bit, does a good job of summarising issues with the term, such as how it makes people think of health only in terms of desperately preventing crap stuff in order to save the NHS…