• By Kevin Mount
  • Posted on Thursday 29th May, 2008

Celebrate the future - but mind that next corner!

The Society for Prevention Research gave center-stage to the long view of its President, Zili Sloboda, yesterday, one of the handful who launched the Society in 1991 and so in an unbeatable position to make shrewd observations about the development of prevention during the last half century – and to read the signs on the trail ahead.Better evidence on potential causal pathways, more effective programs, greater attention to the quality of implementation and a serious attitude to evaluation – there had been encouraging progress in a number of areas, she said. Particularly promising was the recognition among senior scientists in government that much of the variation in children's health and development was explained by malleable behavioral, socio-cultural and environmental influences. It was a clear signal that the role of the prevention expert was beyond dispute. For these and other good reasons she could call her talk “In Celebration of the Future of Prevention Science”.But there was trouble on the horizon. In a squeeze, budgets for prevention were easy targets for cash-strapped governments. In the US, funding had already been cut by up to a quarter. Investments to support the Safe and Drug-Free Schools and Communities Act, for example, fell from $346m in 2001 to $270m last year. As worryingly, in some government quarters, ideology had been allowed to displace science. Prevention of poor sexual health was an example.Back on the plus side, resources were being invested in new professional developments. Given the cross-disciplinary nature of prevention and the fact that it was a young science, it was important to establish how the work of Society members differed from that of the “contributing sciences”, such as psychology, medicine and public policy. In the inaugural meetings, she recalled, participants from a very broad church - geneticists, psychologists, medics, sociologists, epidemiologists and others - found they had as much in common with each other as with their parent disciplines. For many, their professional organizations gave relatively little to prevention.At the start there were just 20 members; now there were over 700. At the beginning the focus was the prevention of drug abuse; now it covered a broad range of impairments to health and development.Among the advances and the indications of a profession maturing was a draft document on the domains and competencies needed by an effective prevention scientist. (Prevention Action will report on this work next week.) The Society was also doing more as an advocate of prevention science by encouraging partnering between researchers and practitioners. With its support, the National Prevention Network, an organization working to prevent alcohol and other drug abuse was linking prevention practitioners around the US. Development of websites and training was a priority.Sloboda also drew attention to another conference theme, Type II Translation Research. Type I translation involves using research knowledge, for example based on studies of the interaction between genes and environment to locate intervention sites; Type II translation research generates the understanding required to take these ideas effectively to scale. A Society task force had prepared an overview and definitions document, she announced. (Prevention Action will report on it next Monday.)

Lessons from a still smoking gun

She ended her survey by reflecting on the enduring lessons from the success of prevention science in relation to the links between smoking and cancer. In 1950, two studies, one in the US and one in Europe, acted as a catalyst that transformed the health of millions of people. Ernst Winder and Evarts Graham writing in the Journal of the American Medical Association quickly followed by Richard Doll and Austin Bradford Hill in the British Medical Journal established a link between smoking and cancer and causes of death. Their work rested on epidemiology and earlier studies in the laboratory.A decade went by and several thousand more articles were published before the US Surgeon General published a report on smoking and health and governments began to act on the evidence. It started with health warnings on cigarette packs, then with the banning of advertising. More research was funded but thirty more years passed before the major community prevention programs were introduced.Drawn out as it had been, the response was regarded as a great success, she explained. But even now the campaign had to continue. The decline in prevalence rates for smoking was flattening out. More efforts were needed to maintain the early advances.So it was clear that effective prevention depended on an understanding of causal processes supported by multiple studies. It was not enough to know that smoking was associated with cancer, it was necessary to know how smoking produced cancer.The influence of a national body with the capacity to support action on the evidence and to resist vested counter interests, was invaluable. This lesson was clear not only in the case of tobacco but also in relation to HIV/AIDS.By the time government was ready to act, scientists had a range of effective interventions ready. There was plenty of evidence about what worked and it had been well assembled.As with medical advances, progress in the prevention of smoking-related diseases had been achieved with a combination of well thought out, well implemented prevention and treatment programs. Prevention was most effective, she said, when it fitted with community norms, when it sat easily in schools, and when the community was onside.

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