Prevention or cure?

We’ve all heard the saying ‘prevention is better than cure’—a little effort now can prevent big problems later. While there’s always going to be a need for reactive, emergency care for those with immediate acute needs, there’s huge scope for challenging the culture of late intervention in public services. Whether it’s chronic health problems, offending, or isolation among older people, we seem to wait until problems reach a crisis and then favour expensive, institutional responses from hospitals, prisons and care homes. In fact, it’s preventative services that are being hardest hit by spending cuts.

So why is this the case? And what can be done about it?

There are a number of challenges around funding prevention (or ‘early action’): identifying and targeting those most at risk of developing problems in the future, evidencing outcomes that can take many years to materialise, and structural issues in government—separate departmental budgets and short political timescales don’t lend themselves to investment in long-term, often cross-cutting preventative approaches.

But cultural issues are perhaps the greatest obstacle to prevention. These aren’t confined to institutions and finance mechanisms, but reach the core emotions and values of every one of us. We’re inclined to support those already in most need, rather than trying to stop future harm—what nef have termed the ‘rescue principle’. You only need to look at charity fundraising campaigns to see that suffering sells.

Funding prevention means shifting spending away from acute, reactive interventions. This raises the question, ‘what happens to those in need now?’ It’s difficult to explain to someone waiting for a hospital bed that the delay is because funding has been diverted to a public health campaign that has less immediate and tangible benefits. Even in more economically stable times there’s a tendency to focus on improving our immediate situation rather than looking to the future.

Prevention’s not always the answer, but there’s much to be gained by at least considering the prospects for intervening earlier.

Children in care is a compelling example. This is a highly vulnerable population that, unusually for preventative approaches, can readily be identified and targeted. Here the focus is typically on care leavers, but by this time it can already be too late—mental health problems, poor educational attainment, crime, teenage pregnancy and drug and alcohol abuse are already disproportionately high by this stage. There’s a strong case for earlier investment in education, employment, and particularly mental health support.

Health charities offer another opportunity. Membership bodies such as Diabetes UK and the British Heart Foundation work to meet the needs of members which often focus on treatment. Improved coordination of the preventative work of health charities offers potential for the sector to increase its influence, and reduce the onset of preventable chronic diseases and potential demand for treatment in the future.

It’s undoubtedly tough to convince funders to invest in prevention at a time of budget cuts. But it’s important to acknowledge the role these types of interventions could play. A cash-strapped government will always tend towards rescue rather than anticipating problems before they happen, but there are things we can do to make a strong case for investment in prevention.

Charities can consider how work can be delivered in ways that will help to ensure that fewer clients require the service in future, developing new approaches to marketing, and better coordinating preventative efforts.

Funders should make sure the way they define need, beneficiaries and outcomes does not discourage prevention. To be more proactive funders can set targets for preventative spending and invest in building the evidence base.

And government need to tackle the structural barriers to investing in prevention with leadership and co-ordination—could an all-party parliamentary group on prevention help stimulate cross-departmental and cross-party action?

To find out more about the policy landscape around prevention and early intervention in the UK, and an appraisal of prevention opportunities in five policy areas, read NPC’s recent report for the Big Lottery Fund.