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Of course it goes without saying that prevention is better
than cure. That is why, in recent years, there has been a growing body of
opinion in favour of putting more resources into health education and
preventive measures. The argument is that ignorance of, for example, basic
hygiene or the dangers of an unhealthy diet or lifestyle needs to be combated
by special nationwide publicity campaigns, as well as longer-term health
education.
Obviously, there is a strong human argument for catching any
medical condition as early as possible. There is also an economic argument for
doing so. Statistics demonstrate the cost-effectiveness of treating a condition
in the early stages, rather than delaying until more expensive and prolonged
treatment is necessary. Then there are social or economic costs, perhaps in
terms of loss of earnings for the family concerned or unemployed benefit paid
by the state.
So far so good, but the difficulties start when we try to
define what the 'proportion' of the budget "should be, particularly if the
funds will be 'diverted from treatment'. Decisions on exactly how much of the
total health budget should be spent in this way 'are not a matter for the
non-specialist, but should be made on the basis of an accepted health service
model.
This is the point at which real
problems occur - the formulation of the model. How do we accurately measure
which health education campaigns are effective in both medical and financial
terms? How do we agree about the medical efficacy of various screening
programmes, for example, when the medical establishment itself does not agree?
A very rigorous process of evaluation is called for, so that we can make
informed decisions.
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