Most Government Agencies tend to do more for the opposite of what they have as their strap-line. The Ministry of Defence tends to go to war, The Ministry of Employment deals with unemployment, the Ministry of Justice deals with Crime and so on.
Example: Denmark’s Ministry of Employment says on its web site:
“The Ministry of Employment has the overall responsibility for measures
in relation to all groups of unemployed persons, i.e. both unemployed
persons on social assistance as well as unemployed persons receiving
In the same way departments of Health have massive funds for dealing with illness and very small funds for promoting health, even though we would all agree prevention is better than cure.
We know from years of study that when you try to help a situation but you have the wrong headline it is not good. And starting with a goal with a negative connotation is also not good, so the first bit of Advice to the President has to be to shift the emphasis, right down the line in all your agencies, health professionals need a different strap-line.
For society, Health is a collaborative exercise, even to the extent that if you have friends who are overweight your risk of getting overweight is much higher, if you have friends with tendencies to paranoia you will risk becoming paranoid and so on.
You will also choose a doctor who is sympathetic to your condition and not one who might challenge it, so you choose a physician who agrees that your problems lie outside of your own control rather than inside it.
So we have a big drug industry which supports an illness focussed society.
Health issues across society tend to change slowly, which is good for policy making in that you can consider with great care how to approach the major issues, and some things are essentially pretty simple in outline, so smoking is generally not good for people, eating too much is not good for anyone, not exercising is not good and mostly we all know mostly what keeps us healthy and what makes us ill, though we might choose to ignore what we know too much of the time.
Some issues are both simple and complex, so treatment of measles is very simple and treatment is massively lower harm than catching the disease, but the compliance of parents to a benefit which ultimately is for society as a whole varies over time periods.
Basically, if 99% of parents have their kids inoculated against measles then there is no big need to have your child inoculated, so every now and then a period arises when fewer parents have this done and rates of measles goes up and then more parents realise the benefits and so on, cycles in cycles.
Some things are unknown now but will be known in the future, over a generation or two, so cancer treatments have gone from pretty unsuccessful in my life time to pretty successful, and maybe soon deaths from cancer will be very low.
Some things are complex and so far look to be pretty unknown, like the rise in obesity, but they might become known and then simple at any time, with the potential for a catalytic change in service provision and guidance on staying healthy.
Or they may just invent an ‘eat what you like and don’t get fat’ pill!
So the Advice to the President, having set out a shift in terminology to emphasise health and not illness, is to support a wide range of open and closed thinking programmes and see which works best.
You can do this wisely because change tends to be slow, long term. Change is a mix of complex and simple and known and unknown and change is mostly collaborative. The bonus is that significant change also can be targeted at reduced costs, there are as many benefits from low cost programmes as high cost programmes, so you can look for lots of low cost and then pay for a few high cost programmes.
As the changes will draw on left brain and right brain thinking, The President needs to avoid approaches which tend to be solely based and reviewed on numbers. A low cost programme may be largely uncostable overall. The diverse changes being sought in society will affect so many different variables, from the costs and incomes of the health agencies and support industries to the tax dollars coming from cigarette smoking and the shorter life of people with lower draw rates on pensions!
So some programmes can be decided on the basis of gut feel for what is right, while other programmes could be costed, such as pre-natal care costs and benefits (I am thinking here of the very clear and catalytic counting that can be done for issues during and immediately after birth – other things like effects on long term education are harder to cost).
Overall, the Advice though is to shift in as many ways as possible, attitudes towards caring for our own health, caring for the health of others, seeing health as an achievable life long ambition. We know some things about how to Nudge people into compliance of this kind. So the Advice is, More Please!
Postscript: If you think getting numbers right is a good thing, and I agree at times it is, then be sure you know what you are doing.
Here is Ben Goldacre reporting to the Parliamentary Science and Technology Select Committee.
It is interesting that the press homes in on his responses to homeopathy and not on his comments about poor evidence in medicine in general.