I just read a BMJ opinion piece here that called for us to ban the use of the word prevention. I agree, but what can we use in it's place? Here's a very quick blog with some rather random thoughts....
The word 'prevention' is so tied up with the 'deficit model of health'. Our health is seen as the absence of sickness. And it is health professionals who determine when we are sick - but as the opinion piece notes health is so much broader; "it's about resilience, adaptability, coping, interdependence, and relationships with others, our community, the planet, and nature". Many of us living with cancer know this only too well!
The challenge is what can we replace the word with? We know that much of ill health is preventable - we know for example more than 50% of cancers could be prevented with the right measures...ban advertising of unhealthy products, introduce taxes on excess sugar and other items, more support to cut smoking, more sport at schools, improved open spaces, walking and cycling, more breast-feeding, etc etc.
Sadly our NHS seems to find any investment in more 'prevention' so difficult - in some quarters it has been dubbed our National Ill-health Service - indeed it has been a huge struggle to find funds to support a Cancer prehab and rehab project in Gloucestershire - yet in many other countries that has been standard practice. So why not more investment when the evidence is so compelling?
When NHS leaders have been asked about prevention, many will argue strongly for it but around half acknowledge they are ineffective at delivering their own prevention priorities. From this same report the leaders identify lack of funding, but other key reasons for non-delivery include a lack of integration of prevention into core services, combined with system capacity issues and the perception that prevention isn’t seen as part of the delivery organisation’s remit are identified as the main barriers to prevention delivery.
Indeed when you look at funding over recent years the picture is pretty bleak..... we've seen cuts to many services - see for example chart from the Kings Fund how this current Government has cut funding to the NHS - also the chart looking at pay to health workers.
Add to that the horrific cuts to Public Health grants - see chart below from the Health Foundation - this will also impact unfairly on more deprived communities where these grants tend to be more focused. The Health Foundation note: "Local authority public health interventions funded by the grant provide excellent value for money, with each additional year of good health achieved in the population by public health interventions costing £3,800. This is three to four times lower than the cost resulting from NHS interventions of £13,500. Interventions can also help reduce health inequalities."
It is notable how our NHS seems to be being run down despite the words of some of our politicians - some would argue this 'running down' is deliberate and aimed at increasing privatisations in our NHS - see for example here.
The Observer's recent investigation into pharmaceutical companies shows how spending on drugs is increasing - see here - and increasing at the expense of patients in some cases. Dr David Unwin, who has spoken at Yes to Life conferences, has championed a low-carb lifestyle that has been shown to reverse type 2 diabetes. He is quoted in the article saying drug industry funding risked distorting treatment; “With so many drug companies paying to advance the pharma agenda, there is an obvious imbalance. No one is pushing the lifestyle agenda and, over time, this is distorting medical practice to an alarming degree.” Indeed the more we have privatisation then the more there is less incentive for wellness.
I started out agreeing we should ban the word prevention but then have fallen into using it through the rest of this blog....how can we create wellness in ourselves and communities? What is the language that can convey the shifts we need?
