The Wisdom of Prevention

Preventing harm is the wise option, adopted far too rarely. More often, we wait until things go wrong and end up coping with the consequences, which is costly and unsustainable.

We must get better at preventing harm – to people, planet and the economy. This calls for long-term planning, upstream investment and early action. It will improve people’s quality of life, make better use of public money, reduce the need for costly state services and help to safeguard the future. Preventing harm is essential if we are to make the Great Transition to a sustainable future.

To build an economy that serves the interests of people and the planet, by promoting well-being and sustainable social justice for all, we have to understand why things go wrong, and tackle the underlying causes of harm – for example:

• For society: tackling the underlying causes of poverty, unemployment, ill-health, illiteracy and homelessness, reducing crime and social conflict, insecurity and distrust, and cutting the need for hospitals, prisons and income support.
• For the environment: cutting greenhouse gas emissions and the risks of climate change, safeguarding natural resources and stopping pollution of air, land and water.
• For the economy: regulating financial institutions to prevent speculation, investing in good jobs and renewable energy, taxing polluters and discouraging carbon-intensive production.

There are different levels of prevention:

• ‘Downstream’ measures try to cope with the consequences of harm and focus on specific cases, to stop things getting worse.
• ‘Midstream’ measures aim to mitigate the effects of harm that has already happened and focus on groups and other things considered ​‘at risk’ or ​‘vulnerable’.
• ‘Upstream’ measures aim to prevent harm before it occurs and usually focus on whole populations and systems.

Sometimes, prevention is needed on all three levels. But ​‘downstream’ intervention should be a last resort. Without tackling the underlying causes of harm, ​‘midstream’ and ​‘downstream’ measures will have little or no lasting effect.

The causes of harm – and the benefits of preventing it – are mutually reinforcing

The underlying causes of harm in society, the environment and economy are often strongly linked and can be mutually reinforcing. So adopting a preventative approach can bring multiple benefits. Examples include encouraging active modes of travel such as walking and cycling, and insulating homes against the cold. These can yield social, environmental and economic dividends.

The case for prevention is increasingly urgent

Climate change is threatening catastrophic damage to the natural environment. Social inequalities are widening. The neoliberal paradigm for managing the economy is in crisis and threatening the future of the welfare state.

Bottom-up prevention is best, but only with enough support

Prevention works best when it involves change from the bottom up: people and organisations acting for themselves, becoming more resilient and less vulnerable. But action at this level needs strong support to tackle the political, economic and cultural factors that have helped to cause the harm in the first place. People need information, education, advocacy and strong leadership to understand and act upon the wisdom of prevention.

There are formidable barriers to change

The logic of prevention seems to contradict the ​‘rescue principle’ that defines philanthropy, charity and most health care. People who want to do good in the world are committed to helping those who are already needy. They may see upstream measures as a diversion. To tackle this problem we must change professional cultures, build up skills, knowledge and experience, and challenge the ethics of failing to prevent harm.

Rescue and cure tend to have immediate, tangible and measurable results, while preventative measures are long-term, more complex and harder to measure. This creates a political bias against shifting the balance of investment upstream. Meanwhile, the neo-liberal consensus favours maximum freedom for markets and minimum state intervention. At the very moment when we most need to move upstream, for social, environmental and economic reasons, the ideas that shape our economy and politics are still pulling strongly in the opposite direction. This is unsustainable.

But now is the best time for change

There is mounting evidence that unfettered markets are failing. Dissenting voices are growing stronger and more plentiful. Now is the time to put the wisdom of prevention at the heart of a new political economy. Change will need to be steady and incremental, winning public confidence through dialogue and partnership at every stage. We must take every opportunity to raise awareness, to show the benefits of early action and build up the evidence base. If we fail, we risk losing the capacity to cope with the consequences of harm.