FROM FLOODING TO HEALTHCARE, WHY ARE WE SO BAD AT PREVENTION?

by Olivia Hanks

Certain things are inescapable at this time of year. Overeating. Musical jumpers. Footage of the prime minister in wellies, assuring a street that’s under three feet of water that the government will do everything possible by way of assistance.

The storms that hit Cumbria, Yorkshire and Lancashire last December flooded 16,000 homes. Estimates of the total cost of the damage, including costs to insurance companies, individual and businesses as well as the cost of rebuilding infrastructure, were around the £5bn mark. Repairs to Tadcaster Bridge in North Yorkshire, which split the town in two when it collapsed on Boxing Day, are still ongoing, with the bridge not expected to reopen until the end of January 2017.

These costs put the government’s autumn statement pledge of £15m for natural flood management measures into perspective. The 2016 budget did promise to raise £700 million for flood defence spending through increasing the insurance premium tax; however, coming so soon after Storm Desmond and Storm Eva, it’s clear this was a political response to events that had already occurred. Billions of pounds of damage might have been avoided if the government had found a way to increase flood defence spending rather than cutting it in the early years of the coalition.

Any amount of additional spending could be ineffective, however, if the government does not change its strategy. We all know that floods will only become worse and more frequent as the climate changes. Yet housebuilding is happening at a faster rate on flood plains than elsewhere – often with no adaptations – and planning documents still discuss flooding as though it were a moderate risk, even in areas which projections suggest will be entirely underwater by the end of the century.

Part of our failure to invest in prevention doubtless stems from the current government’s fixation on cutting public spending. In healthcare, instead of putting money into prevention in order to reduce spending in the longer term, the government is placing heavier burdens onto local authorities by passing responsibilities from healthcare to social care, with no new investment – even as councils explain that they cannot even come close to meeting current demand without more funding.

This kind of mean-spirited, underhand shifting of costs from one public body to another (all ultimately paid for by the same taxpayers) is a result of the ‘competitive’ culture created by this government, which, combined with drastic cuts, leaves everyone fighting over scraps. Norfolk County Council, for example, is proposing to halve its housing-related support budget. As Norwich City Council protested last month, this will put its homelessness services under extreme pressure. This is the kind of damaging dispute that arises when one body funds prevention and another funds ‘cure’.

We have evolved to deal with imminent dangers, but not more distant, complex ones such as climate change or a major healthcare crisis.

Alongside the financial context, however, is a deeper failure to grasp the old axiom that ‘prevention is better than cure’. Humans, it seems, are just not very good at understanding risk. Although early risk perception research assumed that people responded rationally to information about risk, there is now plenty of research demonstrating that our response is based more on emotions than facts. We have evolved to deal with imminent dangers, but not more distant, complex ones such as climate change or a major healthcare crisis.

Humans also love a good story, and cure tends to make for a better tale than prevention: planting trees and building leaky dams – as has been done in Pickering – might be an excellent way to reduce flood risk, but it doesn’t have the narrative drama of locals leaping into boats to rescue their stranded neighbours. This is not to say, of course, that we actually prefer the latter scenario; only that we don’t hear about the former, and therefore don’t tend to consider it as an option.

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Pickering Flood Defence – via ice.org.uk

Something similar can be observed in our society’s attitude to cancer. There is now a large body of research conclusively linking cancer to smoking, obesity and radiation exposure, as well as noting various other possible lifestyle factors (which is not to say, of course, that all cases are attributable to lifestyle). Yet the disease is almost always talked of as a lightning strike of utterly random cruelty. Earlier this year, a study by Cancer Research UK showed that three-quarters of people were unaware that obesity causes cancer. We continue to dream of ‘a cure for cancer’, with its miraculous connotations, ignoring the glaring evidence that lifestyle changes could drastically reduce the number of people affected. We would rather cure our problems than work to prevent them, because a cure is the responsibility of a few clever scientists and engineers, whereas prevention relies on us all.

But why does this flawed perception of risk apply not just to individuals, but also at the level of government, where we might expect expert advice to be more readily heeded? There are cases, of course, where attempts at prevention are repeatedly blocked by vested interests: the junk food, alcohol and tobacco industries, for a start. But given the amount of money preventive measures can save, this cannot be the whole story. Even though our political leaders know prevention is better than cure, they ‘save’ money by not investing in the former, in the hope that the latter won’t be needed until someone else is in power. They also know that preventive schemes don’t make headlines and therefore don’t yield votes.

It is difficult to see how all this could change. A political environment that fosters a more cooperative approach among public bodies would be a start. Perhaps, too, it comes down to empowerment: if we feel that we are ultimately helpless because, for instance, we cannot prevent building on floodplains, it can paralyse us, leaving us unable to take any action at all. When people start to feel that they can make a difference in one area of life, it has a knock-on benefit in other areas.

Whatever the answers, it is vital that we start asking how we get better at prevention; otherwise, we will very soon be facing an ecological crisis for which it is highly doubtful we will find a cure.

Header image: Creative Commons

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