is prevention really better than cure ?

Is Prevention Is Prevention

Really Really

Better than CureBetter than Cure??

DCS John Carnochan QPM FFPH

Scottish Violence Reduction Unit

COSLA - March 2011

“The challenges we face converge, intertwine and often remain largely beyond our understanding. Most of us suspect that the “experts” don’t really know what’s going on and that as a species we’ve released forces that are neither managed nor manageable.”

Thomas Homer-Dixon

(Paper by Prof Phil Hanlon University of Glasgow 2009

Violence – Context Violence – Context

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The The WHATWHAT

“ Interpersonal violence – violence between individuals in families and communities – is a public health problem.”

Etienne KrugDirector

Department of Injuries and Violence PreventionWorld health Organisation

2004

ChallengesChallenges

• Wicked problem – Leaders not technicians

• Partnership in action – policy and Practice• Outcomes not processes

• Assets not deficits

• Public health inspired response

– Interdisciplinary - Collaboration– Evidence-led - problem profile – outcome evaluation

– Prevention focused - earlier, more effective intervention – further upstream

– Whole population - ecological model

birth

Early Years Framework

GIRFEC

Curriculum for Excellence

YJ Framework

Promoting Positive Outcomes (ASB)

Achieving our Potential (Poverty)

Equally Well (Health Inequalities)

Road to Recovery (Drugs)

Alcohol framework

181610

Purpose

Government Economic Strategy

National Outcomes

SOAs

NATIONAL POLICIES

NATIONAL PERFORMANCE

LIFE JOURNEY

Valuing our Young People

More Choices More Chances

– Coalition – Collaboration - Consensus

– Dilution - everyone’s a partner; no-one’s Responsible– Outcomes – clear- defined – Shared – Fragmented delivery landscape

– Territorialism – professional Gangs– Lack of robust outcome Evaluation – Resources – state of public finances – Opportunity?– Leadership – out of the comfort zone – Adaptive

Communities – People

ChallengesChallenges

ChallengesChallenges

•Economics of Prevention:

–Measuring and evaluating outcomes

–Attributing outcomes to interventions

–Identifying agency consequence and benefit

–Measuring value

“There is nothing more difficult to carryout, nor more doubtful of success, nor more dangerous to conduct than to initiate a new order of things. For the reformer has enemies in all who profit by the old order and only lukewarm defenders in all those who profit by the new order”

Machiavelli, The Prince