A dollar of prevention

photo credit: vectorportal.com

It is a well known principle in primary health care that a dollar of prevention saves $19 of cure. (The principle stays the same, only the numbers change).

This means, in simple terms, that preventing you getting heart disease is a lot cheaper than treating your heart disease. And even if you already have heart disease, preventing it getting worse is also cheaper than the treatments down the track. Despite this, prevention and early intervention does not get the dollars they deserve – they aren’t as sexy and exciting as ambulances and emergency departments and high-risk life-saving operations.

So you will be unsurprised that the same is true in disability and schooling.

Education sets you up for life. Literacy levels and educational attainment are linked to not just educational outcomes and job prospects but also health, life expectancy, drug use, teenage pregnancies, abortion, criminality and incarceration rates – pretty much the whole gamut of social indicators. One of the best things about Australia, in my opinion, is the availability of public education (along with socialised medicine).

But schools are struggling to cope with the increase of high-needs children in the classrooms. Increasing diagnoses of learning difficulties and psychological difficulties mean teachers are sometimes trying to teach to children ranging from severely challenged to extremely gifted – and with a large classroom, you can’t really meet the needs of any of them, not even the “average” ones.

Support services for children with additional needs is woeful, and yet this is the time when putting the additional resources in would make a difference to the lives of these children – and to society in general. Services are generally only available to those with severe disabilities – and yet the model of care offered is more suitable to low-needs kids. For instance, public speech therapy services provided through the schools is often an annual or bi-annual assessment by a speech therapist who develops a plan that is implemented by SSOs (school support officers). While many of the SSOs are highly skilled and passionate about the work they do, they are clinically unqualified and are following a set plan that does not provide one-on-one clinical services and is not responsive to a child’s changing needs and abilities. Those who can afford it pay for private speech therapy and the rest miss out.

There are human rights and equal opportunity issues here. Why shouldn’t every child have the opportunity to make the best they can of their lives, open as many doors and find the opportunities they can. But if the human rights issue doesn’t convince you – well it doesn’t make sense economically either.

A child given additional support services in their formative and educational years will be more likely to reach their full potential, more able to give back to society, become gainfully employed and pay taxes, be a productive, participating, law-abiding citizen. They are also less likely to cost society in terms of ongoing support services in their adult lives, increased health care costs, income support, employment services, and if the worst comes to the worst, law and order and justice services. Which is not to say that every child whose needs are unmet is going to become a criminal – not at all. However the jails are full of people with marginal literacy skills.

Our system looks at the short term – cutting costs now is a political vote-winner. Nobody looks down the track to see the cost to society in the long term.

Somewhere on the internet there is a website that demonstrates the link between the social ills – criminality, violence, murder rates, assault rates, high infant mortality, high child death rate, high drug use, high abortion rate, incarceration rates etc, and the seize of the gap between rich and poor. You will be unsurprised to find that the larger the gap between rich and poor, the higher the rate of social ills. The smaller the gap between rich and poor – even if that meant that everyone was pretty poor – the lower the rate of social ills. This pattern holds for countries all around the world, first, second and third world countries, Christian, Muslim, Hindu, Buddhist.

Putting money into education lessens the gap between rich and poor. You can pay now, or you can pay later, but either way, we all have to pay in the end.

Reasons I should be exercising…

(instead of sitting immobile in front of the computer screen)

1. OK starting with the obvious – fitness. This will not prevent me breaking this down into other factors later in this list.

2. Weight loss. My very enthusiastic GP sent me to a variety of very expensive specialists recently. Each said there was nothing wrong with me that losing 20kgs wouldn’t fix. I bit my tongue and refrained from saying “Thanks – I knew that when I walked in. Here’s several hundred dollars for stating the obvious.” These people have very expensive degrees. However, message received.

3. Brain fitness. A recent study by Michelle W Voss from the University of Illinois (Journal of Applied Psychology) has linked exercise with improved mental performance in multitasking, planning and inhibition (not sure whether the latter is a good thing or not). Also good for memory and alertness.

4. Stress relief. Again, going for the obvious. Burning off that excess energy resolves the “fight or flight” adrenaline and other hormone build-up associated with stress.

5. So I can eat all the chocolate I want. Or maybe decrease my cravings for chocolate, as my stress levels will be lowered. Ditto for alcohol, and sugars in general. Seriously though – as well as the calories burned off by exercise, having a higher muscle:fat ratio means more energy is burned off by basic metabolism. Fat does not burn calories.

6. Preventing osteoporosis. Strength training has been shown to prevent bone loss. I am not in the high risk age group for bone loss, but let’s get in early.

7. So the rest of my body can be as fit as my fingers (which are regularly exercised on the keyboard). OK – slightly facetious, but my fingers get a lot of exercise.

8. For mood enhancement. Exercise has been shown to elevate the mood through the production of endorphins. A psychiatrist friend used to take his patients on what he called “circle therapy” where he literally conducted therapy as they walked around the oval. Can’t hurt for the rest of us.

9. Vitamin D. OK, so this is a little bit of a long bow to draw, but with our sun-avoidance as a result of skin-cancer scares, many people are Vitamin D deficient. This can affect nerve health and mood. A little bit of exercise outside, particularly when it isn’t really sunny, is a good thing.

10. Energy levels. As with many things in life, it is a “use it or lose it” proposition with energy levels and fitness. The more energy you expend, the more you get. This one also includes increased mental and physical stamina.

11. Better sleep. Providing you don’t exercise just before sleep. A fit healthy body that has expended a reasonable amount of energy, is much more likely to sleep well.

12. To stave off various types of chronic disease and risk factors. Yes, yes, BORING. But cholesterol, heart disease, high blood pressure, diabetes. I am sure there should be an etcetera there. Sigh.

13. For better self-image. Yes, a fit and taut body would make me feel better about myself.

14. Apparently the above will all give me a better sex life. Enough said.

15. Increased life expectancy. As little as 15 minutes exercise every day can increase life expectancy by three years. More exercise = more benefit. And if you add onto that staving off chronic disease and osteoporosis, it should be a healthier three years as well.

16. Reduced cancer risk. The strongest links seem to be with reduced risk of breast cancer, but lower weight is also associated with a lower risk of bowel cancer and other cancers. The link with reducing breast cancer risk is to do with lower levels of specific hormones associated with developing breast cancer – and the risk reduction can be up to 60%. That’s pretty significant.

17. To beat infectious disease. The evidence is, I believe, a little shaky, but a fitter body means a stronger immune system, means overcoming infectious disease. Can’t hurt.

18. To save my joints. Losing weight through increased fitness will both take the strain off my joints (particularly knees, hips and ankles) and also support the joints with muscle mass. Win-win.

19. To travel the world. A school-friend just FB’d a message that she had started training for the Angkor Wat half-marathon. What a great reason to travel there! I don’t care if I come last, I want to run in the Paris marathon that finishes at the Arc de Triomphe. I am sure there are many other places I could run – and sightsee and shop! Anyone wanna join me?