Prevention may be better than cure but it's not an easy choice.
“Prevention is better than cure.”
It’s an old phrase that‘s pretty hard to argue with. On the face of it, who wouldn’t prefer to prevent ill health over having to cure people? Prevention programmes have been proven to help people live longer in good health, retain greater independence, and deliver ROI. So, it seems like a no-brainer for the government and health systems to pour money into it.
It might surprise you then that just 4% of the UK government’s health budget is spent on prevention. Over the past decade, we are also showing up to the health system sicker and live more of our years in poor health. Prevention doesn’t seem so high up on the agenda. Why?
Look closer, and you’ll see that prevention is far from being a ‘no brainer’ and is full of thorny questions.
First, we face a tricky question on prevention in health systems. That is, “how do we share limited resources between people who are sick today and versus people who might get sick tomorrow”. The sick person needs help today, and their pain is in ‘the now’ and more visible. When you have a large NHS waiting list, prevention is a hard sell.
This situation is complicated further by the issue of “what counts as prevention”? For example, exercising and eating well might prevent me from getting high blood pressure. That’s prevention! But if I have high blood pressure and I need some medication to prevent me from getting a heart attack, what is this? Prevention for heart attacks or treatment for high BP? Diseases are complex, their stages often hard to define so not always clear which activities should count as prevention or even “how much prevention is enough.”
Finally, prevention also requires the individuals involved to be onboard. The “sure, I might have heart disease, but I’m exercising my human right to eat a big mac” argument.
The point is we often simplify prevention as an obvious choice when it is not. We need more clarity on why we should redirect any resources from the sick to the less ill or even to the kinda healthy. It’s not always clear what we mean by “prevent”. It’s also not something we can agree on in terms of importance.
These difficult questions can make it easy to shelve prevention as a strategy.
However, the later and later we intervene in ill health, the sicker and sicker we end up. The more life-changing the consequences of illness can be. The more significant the impact on our autonomy to lead the lives we want.
The more resources we divert away from prevention, the more likely we will end up with more ill health, both in the number of people and severity. Eventually, it becomes a cycle of crises in hospitals. Long term it can be a fatal strategy.
So, whether you call it “prevention” or “early intervention”, it matters. It matters for our individual selves and for our societies too. To make a strong case for prevention though, we have to accept that the case is not “obvious” and start to offer answers to some of the thorny questions.
