IS PREVENTION BETTER THAN CURE? PUBLIC HEALTH POLICY AND THE CIRCULAR STRUCTURE OF LEARNING.

Since the major policy shift from treatment to prevention in the 1970s, public health policy has attempted to counter the rise of lifestyle diseases by an active strategy of health promotion. Instead of only regulating health on a systemic or structural level, this type of strategy aims to get individual citizens to make healthy lifestyle choices, particularly on the four target areas smoking, alcohol, diet and physical exercise. Inspired by the so-called 'new perspective' of the 1974 Lalonde report, this shift has been a key focus of public health policy to this day. Seen across three decades, however, the shift from treatment to prevention does not appear to be a linear learning process, but rather a cyclical repetition of a similar experience of policy failure. Every generation of public health programs presents prevention as the answer to past failures, but the continuous experience of failure is strangely coexistent with sheer optimism about the potentials of new lifestyle policies. The paper tracks this circular learning pattern across both American and Danish public health programs since the 1970s and finds a systematic interpretation of prevention as being more successful and promising than medical treatment. The final part of the paper further discusses why prevention seems to produce these cycles of overly optimistic expectations. Is it simply a consequence of making health care policies dependent upon individual lifestyle choice that citizens will rarely use health knowledge in the right way? Or is it rather an indication that the ideals of preventive public health policy are themselves slippery and that a positive state of health will never be reached for this reason alone? [ABSTRACT FROM AUTHOR]