What’s prevention again?

I’ve had a really interesting day at the Alcohol Early Intervention and Prevention Leadership Summit organised by the London Health Improvement Board and I’m grateful for the invitation to participate in what was a stimulating event.

But it was also perplexing and left me with some questions that I thought I’d throw out into the blogosphere.

When I describe what our charity is about and say that we’re concerned with drug and alcohol prevention I almost never have to say that our focus is with children and young people – that’s a given.

Sometimes we work with families, sometimes with schools or other institutions, and we also lobby for and support environmental interventions, but always with the intention of improving the chances that children and young people grow up with better health and wellbeing.

What today’s conference has suggested is that this isn’t the view of prevention that is currently taking shape in the alcohol world where prevention and early intervention is almost exclusively a description of interventions for adult drinkers.

This leads me to a number of questions.

  • Are we talking about the same things when we use the words prevention and early intervention?
  • What is it that we’re trying to prevent?
  • What are the consequences if prevention embraces adult drinkers.

The same thing?

One of the interesting things of being in the position we’re in is that we get to see the similarities and differences in the cultures that have emerged amongst professionals trying to respond to different substances.

In both sectors there is a focus on the broad environment, and in particular the regulatory framework – with drugs the debate is about the use of the criminal justice system, while in the alcohol field it is currently about the introduction of price controls.  Where they are involved with interventions with individuals

But what seems odd (to me at least) is that there appears to be very little crossover both cultures see themselves as self-contained a lot of the time, rivals for resources and political attention.   Perhaps this is because of the different political arguments that have been made – a focus on reducing crime in the case of illegal drugs and on population health outcomes when comes to alcohol.

The consequence seems to be a shared language being used for very different ends.

I was struck by the fact that when talking to the working group at the Centre for Social Justice earlier this week the phrase “early intervention” was understood to be increasingly about what we do in the first three years of life, while at the summit today it was about interventions with adults attending A&E and in GPs surgeries.

What’s prevention again?

The challenge of a day like today is to find a place for what we do at Mentor – working with children and young people – if alcohol leaders are using the phrase preventions to describe interventions with adults who are drinking heavily and trying to get them to drink more moderately.

At a drug conference this would be called harm reduction.

But if prevention is being extended to include this client group is this broader definition helpful or a threat? Does it provide allies for making an argument for prevention or will it mean that the word looses meaning by becoming all things to all people?

I want to come back to the positives that I got out of the day, and there were lots, but if pressure of time (the next few weeks are a bit full) means that falls off my to do list then please take a look at the Tweets from the day I’ve put together here:

http://storify.com/andrewbrown365/london-iba-summit#publicize

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One thought on “What’s prevention again?

  1. As a health promotion student, I find terminology and the meaning of the terms to often be an issue in the field of health promotion and public health. Words are used interchangeably and it can at times cause misunderstanding and even divert the vision and goals for programs. I will have to say that using prevention to mean harm reduction can even cause the target population to be unreached ( why would someone attend a “drug prevention program” if they are looking for a program which would support their use in a safer manner).

    Harm reduction focus on reducing the consequences of use rather than use itself. There are levels of prevention, prevention that prevent disease (or a high risk outcome), prevention that reduces the complications of a disease by intervening as early as possible and prevention that are rehabilitative or treatment directed at
    those individuals with a known disease. Harm reduction is in its own category.

    I think that at times when people are speaking of harm reduction they tend to hide it behind terms like prevention and other less controversial terms. When meaning harm reduction we should be plain.Terms used in public health/health promotion should also be standardized and in plain language so that everyone can understand its indication.

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