Is prevention really always better than the cure?
The old saying ‘prevention is better than cure’ is frequently used to make the case for more preventive investment across our public services. This sounds intuitively sensible. Why let harm run its course when it could be avoided? But is preventing harm really always the right thing to do?
There is much convincing evidence which demonstrates that investing in prevention can reap benefits for both society and the public purse. When making the case for greater investment the old adage of 'prevention is better than cure' crops up in a great deal of the academic and think tank literature. The rationale is that it is better and cheaper to prevent problems before they arise.
Yet it can be a struggle to entirely accept this. Although there are many instances when prevention is seemingly worthwhile, this assumption is not universally applicable for two main reasons. Firstly, we surely can't prevent every problem. For example we may always need some form of A&E to help plaster cast broken bones, or life boats to rescue people stranded at sea.
Secondly, even if harm is avoidable, do we really always want to prevent it? Take chicken pox for instance. There are vaccinations available for childhood chicken pox but these are not available on the NHS. The reason being is that it is better for children to contract it when they are still young rather than to increase the risk of the more severe shingles in adulthood.
There is also a rather more philosophical point, which is, who defines "harm" and who decides when to prevent it? Equally, whose responsibility is it to do so? This quickly enters the realms of contested political and ethical debate.
At Nesta we greatly welcome the calls for greater preventive investment, but we would argue that alongside this we need to have a much more nuanced understanding of how much spending we actually could and should divert to prevention and what our strategy should be for other areas of potential harm.
To help untangle some of these challenges and to enable the benefits of preventive investment to be realised, we are developing a strand of work to examine the innovations in prevention. This involves making the case for prevention, as well as practical resources, tools and methods to help make it a reality in different areas of public policy.
We would greatly welcome challenge, comments, as well as suggestions on content and wider readings for we should consider and include as our work on prevention develops. If you have any insights you'd like to bring to bear please contact Ruth Puttick, [email protected]