Time to ban the word “prevention”

Few phrases are better known than “prevention is better than cure,” and its message seems irrefutable. Prevention is the favoured answer to the accumulating woes of the NHS: if people don’t get sick then the costs of the NHS will stop rising, although nobody asks what will happen to all those hospitals filled with more than a million staff. Despite its universal popularity, I want to ban the word “prevention.” How can I possibly argue that?

A few years ago, my friend Pritt, one of life’s instinctive radicals and iconoclasts, talked to me about “the deficit model of health.” At first, I didn’t grasp his point, but slowly I came to understand. What is being prevented? Sickness, of course. Prevention leads to health, which is the “absence of sickness.” Health is defined as a deficit, the absence of sickness. And who determines if you are sick? Doctors. If we stick with “prevention” then doctors will determine who is sick and who is “healthy” because they are not sick.

This de facto definition of health conflicts with the definition of the World Health Organisation, which says “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The definition is laughable, divisive, hierarchical, and largely ignored.

It is laughable because to achieve “complete physical, mental and social well-being” is not to be human. Life is difficult, fraught, and constantly threatened. Plus, I suggest, you can be covered in boils and close to death but still “healthy.” Dying is healthy; living for ever would be unhealthy. The definition is divisive because it suggests that physical, mental, and social well-being are separate states and hierarchical because it puts physical well-being above mental well-being and mental well-being above social well-being. (There was a move to include “spiritual well-being” as fourth in the hierarchy, but the move was rejected.) Sickness systems do follow this hierarchy, putting the treatment of physical disease ahead of mental sickness, paying little attention to social wellbeing, and ignoring altogether spiritual wellbeing. The definition is largely ignored because health systems are sickness systems and define people as healthy because they have no detectable sickness—and as definitions of sickness expand (think hypertension or depression) few of us are not sick (and so ”healthy”).

We need a bolder and broader definition of health—something to do with resilience, adaptability, coping, interdependence, and relationships with others, our community, the planet, and nature. Probably we should stop thinking of health being aboyt individuals and recognise that it’s something broader.

Doctors and other health professionals are not the people to define health. A much broader discussion is needed, and getting rid of the word “prevention,” with its deficit definition of health, might spark the discussion—because people will be surprised that such a much-loved word is being abandoned. It will be almost like banning the word “love,” which I do not propose–not least because love is surely part of health.