An ounce of prevention

My sons' tastes run to the macabre.

We were on holidays in Newfoundland in August, and climbed Gros Morne Mountain.  As we were scrambling up the scree, they began to discuss the chance of an avalanche.  Specifically, they wondered about the possibility that we would be trapped by boulders.

"Hey, it would be just like that guy who got trapped when he was hiking and he had to cut off his own arm with a pocket knife!" said one.

"Yeah, he's famous now," replied his brother.  "They just made a movie about him."

In 2003, Aron Ralston had gone hiking alone in Utah without telling anyone where he was going.  After having his arm pinned by a dislodged boulder and spending 5 days (the movie is called 127 Hours) without food or water, he freed himself by amputating his forearm.  He was found by other hikers, and taken to safety.

I remember thinking back then, as Ralston was celebrated as a hero on TV news and talk shows, that although he had showed incredible will and courage, perhaps his ordeal could have been prevented or shortened if he had taken the elementary precaution of telling someone where he was going, and when he could be expected to return.

An ounce of prevention...



This story came to mind again at the end of our holidays when we were visiting in Newmarket, Ontario.  I was walking by Southlake Regional Health Centre and saw these signs:

Before I go any further, let me make this clear: I am not making light of the contribution of this Health Centre.  I am not minimizing any illness that the pictured lady or any other patient suffered, nor the important role medical care plays in treating and curing serious disease.  These signs are representative of many others used in hospital fundraising campaigns across the country.  I am not singling out Southlake; it was just a coincidence that I was passing by their hospital while thinking about this issue.

In healthcare, most of our attention is on acute and chronic care: heart disease, cancer, diabetes and trauma, for example.  Our taxes and charitable donations build hospitals and furnish them with the latest technology.  We pay specialists handsomely to perform complex, life-saving procedures.  We marvel at the latest advances in medical science.

Many people will say, "Of course our attention is on acute and chronic care! What else is there?"  There is Acute and Chronic's demure sibling, Prevention.

It's often said that prophylactic measures, such as clean water and vaccinations, have had more impact on improved health than any other intervention.  But, how many $500 a plate dinners raise funds to promote eating more fruits and vegetables?

Prevention gets less attention for a number of reasons:

Its beneficial effects are not seen for many years, making it difficult for us to link preventative measures to beneficial outcomes.  Those in charge of health care budgets may find it difficult to allocate scarce funds today, when the benefits will not accrue for decades.

Its value is measured across populations. When individuals enjoy good health, it's seen as a normal, baseline state, and not because of some intervention on their behalf. 

The least economically and politically powerful among us may be the ones who benefit most from preventative measures such as smoking cessation, and education about diet and exercise.  

I've heard acute care medicine (derisively) referred to as "rescue medicine".  The point is that health care systems include the maintenance of healthy populations in their mandate, yet they spend many of their resources saving people whose disease could have been prevented in the first place.   What if that kind of contrarian thinking became the norm?  What if we noted the known risk factors for every condition that forced someone's hospital admission, and so kept a running tally of the daily cost of each risk factor?  We would expect hefty government investment in smoking cessation, and promotion of healthy diet and exercise, as a start.

Perhaps the information on Southlake's signs ("40,000 patients and counting") should be seen as a sign of our health care system's failure to prevent disease, rather than a rallying cry to promote expansion of health care facilities.