Prevention: making common sense become common practice

Prevention is a relatively familiar term to those who work in social policy, and was the subject of a major inter-disciplinary conference held by the New Economics Foundation (Nef) on May 9th. We wanted to bring a more systemic focus to the term, and explore how it can also be applied across three spheres of society, environment and economy.

The conference, supported by the BIG Lottery Fund, bought together an impressive range of speakers, including Lord Adair Turner, Margaret Hodge MP, Jonathon Porritt, David Robinson, and Dharmendra Kanani. The speakers represent a wide range of sectors and perspectives, from the economic and financial, to the social and environmental.

Our starting point was the nature of the challenge that faces us, and the choices our politicians make about how to tackle and fund them through public policy and services. We increasingly devote our resources towards dealing with crisis situations, many of which could have been avoided. We need look no further than the bail-out of the banks, the proportion of the NHS budget spent on acute care, the effects of increasing social inequalities, or the degradation of our natural environment.  Many of these issues are closely knitted together and avoidable.

But what might a preventative focus to policy look like? As our recent report The Wisdom of Prevention outlines:

• For society: tackling the underlying causes of poverty, unemployment, ill-health, illiteracy and homelessness, reducing crime and social conflict, insecurity and distrust, and cutting the need for hospitals, prisons and income support.
• For the environment: cutting greenhouse gas emissions and the risks of climate change, safeguarding natural resources and stopping pollution of air, land and water.
• For the economy: regulating financial institutions to prevent speculation, investing in good jobs and renewable energy, taxing polluters and discouraging carbon-intensive production

This may sound like common sense – and indeed, that was a point made by Community Link’s David Robinson, who reminded us that what makes common sense does not always become common practice. In fact, there are precious few examples of this important strategic approach being applied in any systematic way. Even in the health sector, where the idea is perhaps most developed, Margaret Hodge outlined that only 4% of the total NHS spend is devoted to preventative measures, and yet many health conditions are preventable, particularly those that fall into the long term conditions category, which make up about 70% of health spending.

Not only is common sense not yet common practice, but we rarely stop to look at the interdependencies between these spheres and think about how we might use our collective resources more wisely in tackling the challenges we face. Nef’s take on prevention expands the concept beyond the social sphere though, and looks at how the underlying causes of harm in the social sphere, environment and economy are often highly interlinked and can be ‘mutually reinforcing’.

Several examples in the paper showed what applying a preventative approach might look like in practice. One example was taken in insulating homes against the cold, which if done at a national scale, would boost employment and skills. Over time it would reduce the amount spent on the winter fuel allowances that cost taxpayers £3bn a year.  It would also reduce the amount of carbon used in heating homes, and reduce heating bills – benefits across the environmental, social and economic spheres.

But this common sense approach faces substantial challenges in becoming anything like a mainstream approach. To name but a few, the political will needed to take the agenda forward, (though the Scottish Government has made progress in setting out a preventative framework for public services), the challenges faced in effectively evidencing the impact of preventative approaches, the dominant neo-liberal economic orthodoxy, and the ‘rescue’ principles which shape much philanthropic and charitable activity.

Despite these challenges, there seems to be a growing awareness that we urgently need a new way to understand and tackle the underlying causes of harm. Not only to prevent the human burden felt by financial crises, climate change, and poor social outcomes, but because we can’t afford not to. As Lord Turner reminded us at the event, it is the very uncertainty of what the human, environmental and financial costs might be, which makes this approach such a necessity.

• If you didn’t make the conference, you can catch up on it with the full audio on our website, download the full report and a short film of the event on the Nef website.