Saturday, June 26, 2010

The State of Prevention

This week I spent three days at the State Prevention Conference among other “prevention” people - those of us that either are trained to work in or promote the philosophy that preventing problems is the cheapest and most certain way of solving them.

It’s a philosophy that looks good on paper and often even sells politically, but can be extremely difficult to implement. By nature, we are reactionary beings - we see a problem, and we fix it, and then wait around for the next thing to fix. Sometimes this works just fine, but generally people in this position complain that the spend all day putting out fires and never getting and “real” work done.

Second, prevention looks good on paper, but while it is very easy to report all those things that you reacted to and problems you fixed, it’s very difficult to show how many things have been prevented. How can you prove that vaccinations kept 100 kids from getting sick this year? Or, harder yet, that your anti-drunk driving education campaign prevented people from getting in accidents or killed this year? Maybe it was just a lucky year.

Still, it seems the public health approach of trying to keep people from gaining too much weight or smoking or drinking themselves to death is gaining more traction as time goes by. At least, that’s what the pro-health care reform politicians would like us to believe. The prevention community has been promised some very big money in the future by the bill - but it is still up to Congress to appropriate that in the coming years.

That, in essence, was the dynamic of this conference: people from the state capital and people from the counties and cities gathered to share ideas - and realize once again that the people gathered were not speaking the same language.

If there is one consistent thing world-wide, it is that people in the capital cities, be they national or state/provincial, suffer a disconnect from the local level. It is their role in the capitals and capitols, to set the strategic direction and policy for large numbers of people. The nature of this work - negotiations, study, diplomacy, advocacy, lobbying, and straight-up politicking - demands a certain level of academic skill. There is competition for the relatively prestigious, moving-and-shaking jobs in these capitals, so there is a depth of brainpower that can be constantly drawn upon. Plus, it is usually a place of passion and youthful energy. People often play as hard as they work, so there is usually as good an opportunity for a social life as a career. The dynamic, whether with a conservative or liberal bent (or something in between or otherwise), is usually motivated, full of ideas, and ready for change.

Often, however, just the opposite is true outside of the capital city - the further away and the more rural the area, the more extreme the difference. So while many of the representatives of these less politically driven areas sat in the audience, passions and ideas flowing from a capital city speaker were tempered with a quiet, “Yes, but…” from the crowd.

Not always, but often. It is the job of those middle-men in the prevention world to figure out how something that is being decided or developed at the strategic levels can be translated to the local level. It is the job of these prevention workers to take what is given to them and make it reality.

I always leave these conferences full of ideas. It’s also interesting to see later how many of these ideas actually manage to stick. Sometimes you do get a successful statewide (or even nationwide) campaign, such as the ban on indoor smoking in Wisconsin. But those are long term movements that must be fueled with almost constant passion of those at the state level. Motivation and renewed optimism is something we also often benefit from at these conferences. But it is also up to us, those in the middle, to make it clear when passion at the highest level isn’t going to mean a thing to the people that need to actually make the changes.

And in that lies the secret alchemy that determines success or failure of prevention.

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