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Prevention is key

Disease prevention is the new buzz phrase, but one that relies on a sea change in behaviour. Innovative PR and medical education activities could be the way forward

Just put the word 'prevention' into Google and you'll find hundreds-upon-hundreds of organisations, Acts of Parliament and papers focused on prevention - whether it be terrorism, child abuse, accidents or AIDS.

The world we live in is focused on anticipating risk and so reducing the chance of harm to both individuals and society.

And this is more true in healthcare than anywhere else. Keeping people well, rather than fixing them when they are ill, is not a difficult concept to embrace, the hard part is getting people to change not only their views, but their behaviour.

Facilitating sustained behavioural change should empower and enable individuals, but this doesn't account for the stubborn behaviour of the general public. Everyday experience tells us that those who do unhealthy things usually get away with it, with a couple of exceptions - for example, lifelong smokers are very unlikely to get away with any impact on their health.

Even the core preventive activity of the NHS, the immunisation of infants against infectious disease, can be ignored by those who have no memory of diphtheria, whooping cough and polio. For them, what you don't see is what you don't get.

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Vaccination
In terms of the overall costs of the diseases prevented and lives saved, vaccination is one of society's most cost-effective medical interventions.

In the UK, where infectious diseases lead to direct and indirect medical costs, such as absenteeism from work to look after sick children (with corresponding losses of productivity), vaccination campaigns have undoubtedly saved not only suffering, but also considerable sums of money.

These savings are not just to employers and the NHS, but also to the Department of Work and Pensions and to local authorities. Nonetheless, a lot of people, particularly in the UK, have an aversion to taking medicines or having a vaccination when there is, in their mind, no immediate danger.

A recent example of best practice of encouraging vaccination was the 'B Safe' sexual health campaign educating gay and bisexual men about the benefits of being vaccinated against hepatitis B.

While the campaign was supported by Sanofi Pasteur-MSD who, as manufacturers of a hepatitis vaccine, had a vested interest in promoting the message, it was conducted in partnership with the Department of Health, Chelsea and Westminster PCT and the Sorted Clinic - and is one of many recent examples where government and industry have joined forces to promote good health and prevent illness.

The ABPI actively promotes such collaborations insisting that all joint projects must first and foremost be for the benefit of patients (click here). The ground rules for successful joint working are simple and need to be openly acknowledged: trust, mutual benefit, added value, reliability, consistency and integrity, say the ABPI.

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White Paper on Healthcare Outside the Hospital Setting
From a national perspective in England, the focus on prevention is growing.

At the time of writing this, the content of the forthcoming White Paper on Healthcare Outside the Hospital Setting is not known. However, it is anticipated that one of the themes will be investing in preventative public health initiatives - 'upstream commissioning for downstream benefit'.

The government is already investing heavily in smoking cessation and most recently in risk reduction, through the latest proposed smoking ban. In the long-term this will be more cost effective than treating lung cancer. With other preventative treatments in development, such as vaccination for HPV which could potentially prevent the majority of cervical cancer, the government may need to decide whether it is willing to invest for the longer term in other key areas.

There is also a lot of attention on long-term conditions. This embraces the `health prevention' theme, because although people already have one or more chronic conditions, the `preventative' aspect is around preventing their illness from progressing to the next phase for as long as possible. This is yet another place where the pharmaceutical industry can play a huge role.

Practice-based commissioning and Payment by Results will inevitably focus primary care on aspects of health prevention including better management in primary care, prevention of the escalation of conditions that will necessitate referral to the acute sector.

According to the Health Development Agency, the government's public health promotion body, more research needs to be done on ways of preventing and reducing ill health. According to the HDA only 0.4 per cent of public health research published in the UK between 1995 and 2001 related to illness prevention. Clearly there is a role for the pharmaceutical industry to play here.

Modern medicine relies on evidence. This encompasses prevention as well as educational programmes that should prove their worth before being adopted more widely. It is inevitable that some educational programmes are paid for by the pharmaceutical industry - otherwise the work simply wouldn't be done. Public relations and medical education activities play a key role here - conducting pilot education programmes and demonstrating their worth through evaluation.

The industry already spends millions of pounds on the promotion of wellbeing via compliance, patient education materials and disease awareness programmes and is committed to on-going education of healthcare professionals.

A growing interest in a patient-centred approach to care and treatment encourages clinicians to think about ways of integrating patients' perceptions into consultations. There is growing evidence that this integrated approach improves outcomes. But what is the best way to encourage clinicians to think and behave differently?

Clinicians, like everyone else, need to know that approaching their patients in a different or modified way will make a difference to the patient's well-being. Proving education of patients can prevent disease is a route that the industry can take a lead in.

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Opportunities in prevention

Pharmacists
As the experts in medicines, pharmacists have always been known as an accessible and trusted source of advice and treatment. The NHS spends £8 billion a year on medicines and pharmacists have a key role in managing the planning, choice and use of this important resource. The pharmacy contract will provide many opportunities for the pharmaceutical industry to work alongside pharmacists and provide training to enable them in their role as prevention experts. From April, specialist nurses and pharmacists will be able to prescribe any licensed medicine for any medical condition - with the exception of controlled drugs. So their role will significantly increase.

Parents
Research shows that widespread provision of help and support for parents could have an important beneficial impact on future mental and physical health.

Jamie Oliver's 'Feed Me Better' campaign was aimed at improving school dinners in Britain, calling on a ban for junk food and advocating nutritious food instead. His determination paid off when the government promised to spend £280m on improving school dinners across the country.

It was fascinating to see that the campaign's biggest barrier was the parents and adults cooking the school food. They were reluctant to change their own behaviour for the benefit of others, anticipating an uproar from their children.

Education of the public is never going to be easy, but in the words of one CommuniquÈ judge, when Jamie Oliver was given the Judges Award for Outstanding Healthcare Communications; `as PR practitioners we admire what Jamie has done, as parents we are indebted to him.'

The author
Catherine Warne is the managing director of Red Door Communications. She can be contacted at cwarne@rdcomms.com

2nd September 2008

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