Free Thinking, Why are we Stuck on Prevention?

This post will be a free thinking post.  I am trying to get to something but it is not clear.  In this post I will outline my confusion and questions in hopes it leads to answers.  Why are we stuck on prevention?  The evidence is clear, it is not as effective as we need it to be.  I also do this with colleagues an it always helps.

I just finished reading my students philosophy papers again.  My students do this each semester I teach.  I enjoy them because I get to know how they think and they help me learn more.  However each time I read them, I end up with more questions than answers.  Although they all want to do great things, most students are stuck believing they will do great things if they stop doing things that lead to undesired outcomes.  They explain how they would make a better choice to avoid bad without ever saying what they can do or should do to create what they want.  How can  what is desired be created without taking action to create what they want.  This of course relates to my common discussions about, Prevention Can’t Work and Problems are Irrelevant!

How do I get to the point where it is clear prevention cannot work to create what is desired.  Most understand creating a desired life increases capacity and potential to overcome, withstand, and recover from any bad things that do happen.  Even though most know all bad cannot be avoided, they still focus on prevention. No matter what we do, all bad things cannot be avoided.  It is also important all bad things are not avoided because when we meet unexpected challenges, we develop and use skills we never knew we even had.  We also must understand good or bad is only made so by how we think about it.

I recently heard more about population health efforts from Ray Fabius. With population health efforts, supposed less bad is shown from these efforts.  People did not die, suffer diabetes, have heart disease etc.  How can you know it worked?  How do you know it would have happened? You can’t.  If it works, nothing happens.  Hard to motivate people to achieve nothing.

People suggest, if you prevent they will be able to do more. Possibly, but why would they be able to do more.  What new skills do they have? How has their capacity, their alliances, their partnerships increased that would enable them to do more?  Efforts for prevention are focused on creating a wall against oncoming obstacles that may, although it is uncertain, be barriers.  In other words, successful population efforts may result in less targeted problems treating for without creating a path to getting more done.  It seems efforts could focus on building more skills, abilities or connections.  Difficulties of success from prevention is documented and outlined by Geoffrey Rose (my next post will share more about this book).

Geoffrey Rose has demonstrated in The Strategy for Preventive Medicine, how traditional efforts are insufficient to improve health status of the population.

9780192630971

Although, as in most fields, it seems appropriate to use a targeted rescue effort for vulnerable interventions, prevention, it is an inadequate response.  Besides it is reactive and not proactive, it is acting after exposed so at best all it can do is fix or repair rather than create better.  Besides success is hard to determine because grateful patients of prevention are few and SUCCESS IS MARKED BY A NON-EVENT.  As Rose states, targeted approaches can assist but they are insufficient and may not be necessary.  Instead he suggests focusing on social or societal risk factors.  Although this may be better, success would still be documented by non-events on a population level.  Better but still insufficient.  As Thomas Friedman has noted, freedom from something as can be done with a revolution is easier than freedom to something that must be created.  Many unintended negative side effects such as isolating problem populations results from these good intentioned efforts.

When prevention efforts, population or individual, what is there to point to for these effort. What was accomplished that cause pause, that make people say, wow!  This is where were we need to aim our efforts.  We should do great things because this is what most people hope to achieve and do.

Problems are endless, if the focus is on fixing problems the job is never done and the best result is not bad instead of better than it could have been otherwise.  As we all know, once we fix one problem, another materializes and we must attend to that.  As Tolstoy explained,

“All happy families are alike; each unhappy family is unhappy in its own way.”

Just like families, problems have many reasons while success has similar causes. Instead of attending to problems, we should focus efforts on building skills, abilities, connections that generate comprehensive improvement by creating pervasive, reciprocal, selfish, selfless, synergistic interactions so everyone and everything benefits which is the practice of paneugenesis.

When we practice paneugenesis, we are likely to experience progress because we can feel like we are moving closer to internally generated goals.  To me, and it seems many agree, progress is what it is all about and is also why I suggest we experiences wellness, a positive health phenomenon, during progress (see Experiencing Wellness = Progress Toward Desired)

 

A big confusion I have is that many people may think they are already creating positive as they work to prevent bad. David McRaney, in his book, “You are not so smart: Why you have too many friends on Facebook, why your memory is mostly fiction, and 46 other ways you’re deluding yourself“, suggest some reasons why we think we are always right, even if we are wrong. Its our evolutionary predisposition and it protects us. This point was also described well in Julia Galef’s TED presentation, “Why You Think You’re Right – Even if You’re Wrong“. In this presentation she discusses how this tendency led to false accusations in 19th Century France. This predisposition also explains much about our past, present and if we work on it, can be used to improve our future.

As always, please share your thought about how you are creating good.  I look forward to hearing from you and hearing about how you use pervasive, reciprocal, selfish, selfless, synergistic interactions to generate All Good so everything and everything benefits!

Be Well’r,
Craig Becker
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