Christopher Dye - The Great Health Dilemma

It may seem self-evident that prevention is better than cure, but we seldom act as if we believed it. In this brilliant work, Christopher Dye describes the many ways prevention is undervalued in comparison to its demonstrable benefits. Everyone who cares about the publics healthand their ownhas much to gain from absorbing Dyes lessons.

Harvey V. Fineberg, President, Gordon and Betty Moore Foundation

In a chapter on unlikely disasters, Chris Dye explores pandemic preparedness as a highly topical example of prevention. Invoking principles used throughout the book, he argues that Covid-19 should be seen not as an isolated, once-in-a-lifetime event, but rather as one among hundreds of outbreaks of infectious diseases that are recorded each year. Borrowing ideas from the insurance industry, he suggests pooling all risks and sharing the costs to fund the development of generic platform technologies precursors for diagnostics, therapeutics and vaccines that can be into called into action to combat a wide variety of pathogens as they emerge. This is a book for all who are concerned about the disruption of our planet, and about the increased opportunities that it creates for emergence of infectious pathogens at the animal/human interface.

David L. Heymann, Professor, Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine

By incisively dissecting the dialectical relationship between prevention and treatment of illness, Chris Dye has laid bare one of the great contradictions in health. His razor-sharp analysis unravels the complexity of our values and choices that has seen prevention remaining a poor neglected cousin of treatment. A truly enlightening book - a must-read!

Salim S. Abdool Karim, CAPRISA Professor of Global Health, Department of Epidemiology, Mailman School of Public Health, Columbia University

Using the example of TB, Chris Dye explains that by addressing the underlying risk factors and determinants for the disease, one would in fact be preventing a host of other health conditions and improving wellbeing. While biological and immunological reasons make finding a vaccine for TB challenging, we should also be addressing environmental, economic, and social risk factors for ill health.

Soumya Swaminathan, Chief Scientist, World Health Organization

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The proverbial benefits of prevention over cure are, on the face of it, self-evident. A healthy life is one spent free of illness, and in full fitness, until the moment of death. That is surely better than struggling against acute, chronic, or recurrent bouts of sickness. Based on that sentiment, it is no surprise that the preference for prevention over cure has been expressed, in assorted ways, throughout human history.

But if prevention is so desirable why, paradoxically, do we invest so little in staying healthy and so much on curing illness?

Health professionals argue that we should spend much more than 3% based on a large volume of economic analysis, which finds that prevention is often cost-effective and sometimes even cost-saving.

Across the European Union in 2015, around 570,000 deaths (out of 1.7 million deaths in people under 75 years) could have been avoided if healthcare systems had offered timely and effective medical treatments. But many more deathsover a millioncould have been avoided by better prevention and public health.

The benefits of prevention come from avoiding hazards from the environment (such as polluted water and unsafe sanitation), from metabolic To the extent that these factors can be modified, they should be targets for preventing ill health.

Such facts about the preventable causes of illness and death, and many more like them, are frequently recited. Less thoroughly studied, with a few notable exceptions, The pathway to better prevention comes, not from insisting that it is the right course of action, but from understanding why many people behave as if it is not, and why they might change their minds.

The paradox of disease prevention is actually the dilemma faced by any organism carrying any assets into an uncertain future. With regard to human behaviour, the dilemma implies that we want to know, not merely that prevention and treatment are options, but what motives lead to the choice of one over the other. Rational does not necessarily require conscious decision making by a selfish Homo economicus exercising free will (Econs, as Richard Thaler called them). It suggests that the observed choicesthe product of biological, behavioural, and cultural evolutionare made because they confer an advantage, and that they are susceptible to reasoned explanation, even if the reasons are not immediately obvious (at first sight irrational). This is a book about humans rather than Econs.

In making a better case for investing in good health, unreasoned advocacy for safer and healthier lifestyles is generally unpersuasive. The rhetorical view, for instance, that salus populi suprema lex (public health must be the highest law) resonates mostly with those who already agree.