This submit continues the dialogue that begins in What’s politics? It informs a chat on prevention for Public Well being Affiliation Australia Preventive Well being Convention 2025 ‘Prevention is Political’
The politics of prevention entails (1) deciding who’s accountable for (2) translating the obscure idiom ‘prevention is healthier than remedy’ into concrete selections about what prevention is, what coverage options and processes would change, and the way a lot of a precedence it needs to be.
For instance, our e book Why Isn’t Authorities Coverage Extra Preventive? (free Introduction and Conclusion) compares two methods to make sense of prevention and provoke political debate.
First, in public well being, prevention can discuss with a selected agenda to stop or cut back non-communicable ailments (NCDs) related to smoking, alcohol, unhealthy meals, inactivity or weight problems, or air pollution. For instance, ‘complete tobacco management’ entails excessive state intervention to provide a set of coverage devices, reminiscent of rules on tobacco merchandise, how firms can promote, and the place folks could smoke; taxes and duties to lift the value; providers to assist folks cease (or be handled for ill-health); and well being training (together with stark messages on merchandise) (e.g. within the UK).
The politics of tobacco contains debate on (1) methods to body the problem, reminiscent of a authorized product with financial worth or a dangerous substance contributing to an epidemic of NCDs and well being inequalities, and (2) how far the state ought to intervene, from solely giving data to prohibiting behaviour. In international locations just like the UK and Australia, maybe this debate has been gained, but it surely took many years to translate proof into coverage, and there stays excessive contestation every time a authorities proposes a brand new instrument, reminiscent of to ban smoking in vehicles with kids or elevate the smoking age annually.
Second, prevention generally is a extra ambiguous agenda for coverage change and policymaking reforms, together with Well being in All Insurance policies but in addition wider social coverage or preventing-spending initiatives throughout authorities. In Why is well being enchancment coverage so tough to safe? and new analysis we relate key obstacles to progress – prevention coverage’s lack of readability, congruity, and capability – to unresolved and contested selections.
Deciding what prevention means (‘readability’)
The politics of prevention contains (1) the extent of state duty and intervention (what coverage devices to make use of), and (2) the allocation of sources to ranges of prevention or particular social teams.
For some, prevention symbolises an ethical agenda to help social justice: there needs to be excessive state intervention to stop or cut back poor outcomes (reminiscent of sick well being) and inequalities (such because the unequal unfold of NCDs). State intervention may embrace taxing and spending to scale back financial inequalities, or the reallocation of public providers to mitigate their affect. There could also be an specific coverage to scale back inequalities in relation to components reminiscent of race or ethnicity, gender, or incapacity (reminiscent of laws to problem discrimination).
For some, prevention symbolises extra pragmatic or urgent goals, reminiscent of to scale back demand on public providers. It’d contain excessive state intervention to affect enterprise and social behaviour, a push to combine public providers, or a give attention to giving folks extra details about methods to enhance their very own wholesome behaviour. Lowering well being inequalities could also be a major intention or byproduct of such insurance policies.
There may be additionally some doubt about which degree of prevention to prioritise: major prevention, or essentially the most formidable ‘upstream’ complete inhabitants measures; secondary prevention, to determine interventions for teams susceptible to hurt; and, tertiary prevention, to stop present circumstances getting worse. You possibly can agree with all three, however allocating extra sources to at least one suggests fewer sources for one more.
Rising political points may additionally differ by sector, reminiscent of to spotlight the allocation of tertiary sources based on age in healthcare (e.g. providers for older folks) or the secondary prevention downside of figuring out at-risk teams in social coverage (e.g. early intervention for kids and oldsters).
Deciding what ought to change (‘congruity’)
Prevention could be bought as a radical various to the established order or a way to mainstream prevention in routine authorities enterprise.
The unconventional agenda is clearly ‘political’, together with a direct problem to the coverage options and processes contributing to poor and unequal outcomes.
Nevertheless, agendas like HiAP, and preventive goals in public service integration, usually search to depoliticise this course of, reminiscent of to emphasize pragmatism and win-win options based mostly on attempting to mainstream public well being or match prevention concepts into present authorities routines. Right here, we could give attention to ‘political astuteness’ to attach new goals to the agendas of elected politicians, the ‘micropolitics’ of cooperation when skilled and organisational guidelines or cultures collide, or one type of policymaking undermining one other (e.g. Godziewski on the EU guidelines and norms that undermine HiAP by favouring financial goals and together with trade actors in public well being coverage).
Deciding between goals and setting priorities (‘capability’)
Getting high-level help for an agenda like ‘prevention’ could look like a win. Nevertheless, a authorities’s rhetorical dedication to a brand new agenda can sign (1) honest and energetic help, or (2) the will to make use of a buzzword as a substitute for motion.
Certainly, it’s common in public well being and social coverage analysis to narrate this downside to politics: an absence of ‘political will’ to show a brand new dedication into concrete motion when (1) politicians face opposition from vested pursuits, and/or (2) their larger dedication to ‘neoliberalism’ (to favour financial development and restrict state intervention) overshadows their dedication to scale back inequalities.
On this case, insights from coverage course of analysis relate to the necessity to make an analytical separation between:
- the precise political motion (or inaction) that undermine progress, and
- the systemic limits to coverage change when policymakers have interaction in a fancy policymaking surroundings over which they’ve restricted understanding and management.
In different phrases, what are the dynamics that can undermine progress (in the direction of integration or coherence) even when prevention is backed by essentially the most honest and energetic politicians? This thought-exercise helps to keep away from the belief that any lack of progress is brought on by poor politics or low-energy politicians.
We may additionally mix 1 and a pair of to determine the impact of high-level political selections on preventive policymaking. For instance, in ‘Westminster’ methods, the macro-political alternative is to take care of and prioritise excessive stakes accountability by way of frequent elections, with main knock-on results together with: devoting most political consideration, sources, and efficiency administration to short-term success in relation to high-profile providers reminiscent of healthcare. This focus comes on the expense of prevention, particularly if the story is of funding for the long-term that struggles to suit into short-term measures of success (e.g. within the UK).
Now learn on:
I additionally made pretty related factors as a part of an ANZSOG tour again within the day, together with: Prevention is healthier than remedy, so why aren’t we doing extra of it?
This submit continues the dialogue that begins in What’s politics? It informs a chat on prevention for Public Well being Affiliation Australia Preventive Well being Convention 2025 ‘Prevention is Political’
The politics of prevention entails (1) deciding who’s accountable for (2) translating the obscure idiom ‘prevention is healthier than remedy’ into concrete selections about what prevention is, what coverage options and processes would change, and the way a lot of a precedence it needs to be.
For instance, our e book Why Isn’t Authorities Coverage Extra Preventive? (free Introduction and Conclusion) compares two methods to make sense of prevention and provoke political debate.
First, in public well being, prevention can discuss with a selected agenda to stop or cut back non-communicable ailments (NCDs) related to smoking, alcohol, unhealthy meals, inactivity or weight problems, or air pollution. For instance, ‘complete tobacco management’ entails excessive state intervention to provide a set of coverage devices, reminiscent of rules on tobacco merchandise, how firms can promote, and the place folks could smoke; taxes and duties to lift the value; providers to assist folks cease (or be handled for ill-health); and well being training (together with stark messages on merchandise) (e.g. within the UK).
The politics of tobacco contains debate on (1) methods to body the problem, reminiscent of a authorized product with financial worth or a dangerous substance contributing to an epidemic of NCDs and well being inequalities, and (2) how far the state ought to intervene, from solely giving data to prohibiting behaviour. In international locations just like the UK and Australia, maybe this debate has been gained, but it surely took many years to translate proof into coverage, and there stays excessive contestation every time a authorities proposes a brand new instrument, reminiscent of to ban smoking in vehicles with kids or elevate the smoking age annually.
Second, prevention generally is a extra ambiguous agenda for coverage change and policymaking reforms, together with Well being in All Insurance policies but in addition wider social coverage or preventing-spending initiatives throughout authorities. In Why is well being enchancment coverage so tough to safe? and new analysis we relate key obstacles to progress – prevention coverage’s lack of readability, congruity, and capability – to unresolved and contested selections.
Deciding what prevention means (‘readability’)
The politics of prevention contains (1) the extent of state duty and intervention (what coverage devices to make use of), and (2) the allocation of sources to ranges of prevention or particular social teams.
For some, prevention symbolises an ethical agenda to help social justice: there needs to be excessive state intervention to stop or cut back poor outcomes (reminiscent of sick well being) and inequalities (such because the unequal unfold of NCDs). State intervention may embrace taxing and spending to scale back financial inequalities, or the reallocation of public providers to mitigate their affect. There could also be an specific coverage to scale back inequalities in relation to components reminiscent of race or ethnicity, gender, or incapacity (reminiscent of laws to problem discrimination).
For some, prevention symbolises extra pragmatic or urgent goals, reminiscent of to scale back demand on public providers. It’d contain excessive state intervention to affect enterprise and social behaviour, a push to combine public providers, or a give attention to giving folks extra details about methods to enhance their very own wholesome behaviour. Lowering well being inequalities could also be a major intention or byproduct of such insurance policies.
There may be additionally some doubt about which degree of prevention to prioritise: major prevention, or essentially the most formidable ‘upstream’ complete inhabitants measures; secondary prevention, to determine interventions for teams susceptible to hurt; and, tertiary prevention, to stop present circumstances getting worse. You possibly can agree with all three, however allocating extra sources to at least one suggests fewer sources for one more.
Rising political points may additionally differ by sector, reminiscent of to spotlight the allocation of tertiary sources based on age in healthcare (e.g. providers for older folks) or the secondary prevention downside of figuring out at-risk teams in social coverage (e.g. early intervention for kids and oldsters).
Deciding what ought to change (‘congruity’)
Prevention could be bought as a radical various to the established order or a way to mainstream prevention in routine authorities enterprise.
The unconventional agenda is clearly ‘political’, together with a direct problem to the coverage options and processes contributing to poor and unequal outcomes.
Nevertheless, agendas like HiAP, and preventive goals in public service integration, usually search to depoliticise this course of, reminiscent of to emphasize pragmatism and win-win options based mostly on attempting to mainstream public well being or match prevention concepts into present authorities routines. Right here, we could give attention to ‘political astuteness’ to attach new goals to the agendas of elected politicians, the ‘micropolitics’ of cooperation when skilled and organisational guidelines or cultures collide, or one type of policymaking undermining one other (e.g. Godziewski on the EU guidelines and norms that undermine HiAP by favouring financial goals and together with trade actors in public well being coverage).
Deciding between goals and setting priorities (‘capability’)
Getting high-level help for an agenda like ‘prevention’ could look like a win. Nevertheless, a authorities’s rhetorical dedication to a brand new agenda can sign (1) honest and energetic help, or (2) the will to make use of a buzzword as a substitute for motion.
Certainly, it’s common in public well being and social coverage analysis to narrate this downside to politics: an absence of ‘political will’ to show a brand new dedication into concrete motion when (1) politicians face opposition from vested pursuits, and/or (2) their larger dedication to ‘neoliberalism’ (to favour financial development and restrict state intervention) overshadows their dedication to scale back inequalities.
On this case, insights from coverage course of analysis relate to the necessity to make an analytical separation between:
- the precise political motion (or inaction) that undermine progress, and
- the systemic limits to coverage change when policymakers have interaction in a fancy policymaking surroundings over which they’ve restricted understanding and management.
In different phrases, what are the dynamics that can undermine progress (in the direction of integration or coherence) even when prevention is backed by essentially the most honest and energetic politicians? This thought-exercise helps to keep away from the belief that any lack of progress is brought on by poor politics or low-energy politicians.
We may additionally mix 1 and a pair of to determine the impact of high-level political selections on preventive policymaking. For instance, in ‘Westminster’ methods, the macro-political alternative is to take care of and prioritise excessive stakes accountability by way of frequent elections, with main knock-on results together with: devoting most political consideration, sources, and efficiency administration to short-term success in relation to high-profile providers reminiscent of healthcare. This focus comes on the expense of prevention, particularly if the story is of funding for the long-term that struggles to suit into short-term measures of success (e.g. within the UK).
Now learn on:
I additionally made pretty related factors as a part of an ANZSOG tour again within the day, together with: Prevention is healthier than remedy, so why aren’t we doing extra of it?
