A dollar of prevention

19 11 2011

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.

The fruits of inequality

10 08 2011

The newspapers, televisions and radios are full of commentators trying to make sense of the terrible events taking place in Britain.

While there is no excuse for criminality or violence, and I am in no way defending the people taking part in this, there is one particular line of speculation which rings true with me. And I am going out on a limb because I know that some of you, and even some of my dear friends, will find what I am about to propose to be anathema.

Desperate people do desperate things
There is a growing body of evidence that shows that the gap between rich and poor is associated with a grab-bag of negative indicators in society: criminality, violence, incarceration rates, drug use, teenage pregnancy, high abortion rates, poor education rates, unemployment, poor health, (etc).

It seems that it is not poverty in and of itself that is the issue, it is being poor while your neighbours are wealthy. It is the comparative disadvantage that drives people to despair and desperation. It is the lack of hope, that you can ever compete, ever claw your way up the slippery slope.

Following this theory, and excluding instances of severe deprivation such as is currently happening in the horn of Africa, being poor when all around you are approximately the same level of poverty, is OK psychologically.

This fits in with psychological theory (and my psychologist friends can fill me on on the name of the theory) about happiness being a relative term. If you are miserable and everyone else around you is miserable, this is tolerable – normal even. But if you are miserable surrounded by happy people – that makes your misery less bearable.

I am not trying to say that being wealthy is a bad thing. It sure beats the alternative. I think what those who are blessed or lucky, or whatever your understanding of all this is, need to ensure that they don’t pull the ladder up behind them. By all means climb the ladder – just make sure it is there for others as well. Maybe what we all need to survive collectively as a species and as a community, to avoid becoming desperate, is hope.

In the recent GFC apparently a large number of youth centres and clubs were shut down. While the British Government may congratulate itself on its cost cutting to keep the British economy out of the crises currently hitting Greece, Ireland and hanging over the heads of other European countries, the people paying this price are the youth in the lower socio-economic classes. Apparently they don’t feel they have anything to lose.

I spent some time tonight trying to find a website that used to exist that linked all of this data. I couldn’t find it. But I did find a number of articles from peer-reviewed journals that covered the same ground. If you are interested, try googling “gap between rich and poor” and “crime rate” or any of the above indicators.

Hindsight is a marvellous thing.