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PUBLIC HEALTH

Examining the forces that push problems downstream

The pandemic has created opportunities for learning, renewal, and new, better responses, says Graeme McDonald. The pro-early intervention arguments appear to many mere common sense, so why is investing early so difficult, he asks.

While dominated by our fight against this terrible disease, lockdown has also created some space for reflection, in particular around the direction of the sector, the future we were (pre-COVID-19) heading toward, and where would we rather be.

Earlier intervention and prevention has long been a policy goal for the sector. Whether it stemmed from the ‘wicked' issues first pinpointed by George Jones and John Stewart in the 1990s, the now 10-year-old Marmot Review, or devolved skills funding, frequent battles have been fought with, and alongside, civil servants arguing the social and financial case for greater investment upstream of the nation's big challenges.

Now a public health crisis has brought into very sharp focus the impact of ignoring future risk. Whether it's the scarcity of preparation for a pandemic or the impact on low income and BAME communities, the results of years of underinvestment in public services, and preventative services, is clear. We will have to respond more proactively to climate change, learn more effectively from our past and be more forceful in the early support of disadvantaged communities.

The pro-early intervention arguments appear to many mere common sense. So why is investing early so difficult?

In Dan Heath's recent book, Upstream, he sets out three forces that push problems downstream to be dealt with later: problem blindness; a lack of ownership; and tunnelling, all of which resonate throughout the public debates of the past decade.

Problem blindness occurs when issues are normalised and negative outcomes believed to be inevitable or even natural. Lack of ownership is self-explanatory and is particularly prevalent when responsibility is fragmented, self-interest intrudes, and groups feel a lack of legitimacy or standing. Tunnelling happens when problems left undealt with result in the short-term heroism of ‘saving the day', which itself becomes rewarding – self-perpetuating, yet strategically impotent.

It is hard to argue that all these forces do not remain strong both in the wider public sector, but also within local government. And while this pandemic has created opportunities for learning, renewal, and new, better responses, it is likely to take many hard yards of robust evidence gathering, and heart-changing storytelling to make early intervention the norm.

Graeme McDonald is managing director of Solace

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