My first reaction when I read Bernard Keane’s critique of prevention, published in Crikey earlier this week, was of irritation. Then I sat back and marshalled my thoughts and arguments. Then I read Simon Chapman’s response, and some of the subsequent discussion on the Crikey website and in other places.
And then I was glad, sort of, for the opportunity for reflection and debate that Keane had delivered.
Continuing the discussion, Professor Bruce Armstrong, Professor of Public Health at the University of Sydney, adds this comment:
“The key point of weakness in Bernard Keane’s argument is this phrase “in the health economics literature”.
Preventive interventions that have been evaluated to the standard required to be included in the Tufts–New England Medical Center Cost-Effectiveness Registry of “published cost-effectiveness studies”, on which the New England Journal of Medicine article was based, are all or almost all interventions targeted to individual people.
The major preventive successes of public health have generally achieved most of their effect through interventions targeted to whole populations, which have not been and cannot be evaluated with the rigour required to make it to the Cost-Effectiveness Registry.”
To which I would add that Bernard’s article seemed to make the mistake of assuming treatment equals cure. As the NHHRC report has just pointed out, plenty of money is being wasted on ineffective tests and treatments. To suggest that public health and preventative programs should be based, wherever possible, on evidence that they will bring a reasonable return on investment is not nearly so controversial as Bernard seems to think. For example, this resource outlines the evidence base for various public health interventions.