Hazardous good intentions?: Unintended consequences of the project of prevention
Dorothy H Broom
National Centre for Epidemiology & Population Health, Australian National University, Canberra, ACT
PP: 129 - 140
Abstract
Preventing disease is by definition a valuable objective, and most debates have revolved around improving the effectiveness of prevention. In this discussion, I explore the latent functions - the unintended consequences - of what I call the ‘project of prevention'. Although many latent functions are welcome, some have undesirable effects, and it is therefore important to instigate a rich exchange between innovative theory and rigorous research to minimise such effects. I argue that the hazards are particularly acute in the absence of a reflexive and critical awareness of the political environment and the cultural economy within which prevention occurs.
In the paper, I sketch the challenges to mobilising that awareness, show some of the limitations of the conventional theoretical approaches to prevention, and point to directions for developing more fruitful perspectives.
Keywords
health promotion, class, gender, sociology, latent functions
Article Text
The project of prevention as it is defined and practised in the early 21st Century arises from a history of good intentions. The prevention of disease and injury, and the maintenance of good health, have long been recognised as preferable to therapeutic intervention. Prevention averts pain and suffering, and is generally believed to be more cost-effective than medical care. The term ‘prevention', however, is not limited to stopping health problems before they start. Particularly when clinical care is being discussed, ‘prevention' is typically subdivided into primary, secondary and tertiary types. Only primary prevention involves avoiding ill-health before onset. The term secondary prevention is used to refer to early detection of asymptomatic people, while tertiary prevention has become another name for medical care that strives to restore an optimal level of health and functioning in a person with established disease (US Preventative Services Task Force 1996).
Although my interest is mainly in primary prevention (particularly community-based rather than clinical), I touch on the other forms, and note here that the distinctions between them presume boundaries that are empirically and experientially more blurry than the definitions might suggest. The proliferation of meanings complicates the task of re-imagining, but it is indicative of the contemporary discursive and socio-political context within which health care and prevention occur. This context, and the way the definitions and implementation of prevention have developed, contribute collectively to the unintended effects which form the subject of this paper.
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