An ounce of prevention is worth a pound of cure. The current coronavirus public health crisis is a painful reminder of the value of early public health interventions.

In more technical jargon, this is the prevention dividend, referring to the savings generated by investments in public health upstream, thus preventing diseases and reducing illness-related expenses downstream.

The current ballooning public expenditures to avert a social meltdown following the economic downturn due to COVID-19 - not to mention the many human lives lost – is sadly reminding us of this basic principle of public health and health promotion: an ounce of prevention is worth a pound of cure.

A reminder also how in ancient Greece, the goddesses of health were Hygeia and Panakeia, two sisters on equal footing: one in charge of the maintenance of good health and the prevention of diseases (hence the term "hygiene”, including… washing one’s hands); the other one responsible for remedies and curing diseases (hence the term "panacea").

The problem in our modern days is how positive health is difficult to evaluate in dollar terms. Indeed, it is hard to prove that someone did not get sick because specific preventive and health promotion measures. On the other hand, it is much easier to measure the direct and indirect costs of a particular disease.

Unfortunately, it takes the kind of pandemic we are faced with currently, to realize the sheer value of the prevention dividend (or public health dividend).

BOOSTER SHOT FROM SARS IN 2003

And yet...

Canada received a powerful booster shot with the SARS crisis back in 2003. Toronto was hit with an epidemic, slapped with a no travel advisory by the World Health Organization and put on a global quarantine.

Part of the lesson has been learned: the need to reinvest in our public health infrastructure.

Indeed, the Public Health Agency of Canada was one of the recommendations of the expert report "Lessons from the SARS Crisis: Renewal of Public Health in Canada", published in October 2003 by Health Canada, to avoid in the future the black eye on the international stage and the economic hangover after the SARS epidemic in the Toronto region.

Lest we forget, how at the time, in Spring 2003, Ontario was practicing hallway medicine, after the so-called common sense revolution of the Mike Harris government cut off the tap for public investments at the provincial level, while at the federal level, the financial weight-loss boot camp led by Jean Chrétien’s Finance minster, Paul Martin, was bulldozing full steam through public accounts.

WALKERTON TRAGEDY IN 2000

And yet...

Before that, a serious alarm bell rang loud and clear: the Walkerton tragedy in May 2000, when six Ontarians died simply from drinking tap water, contaminated with E. coli.

Premier Harris had to publicly apologize in 2002 for his government responsibility for the tragedy, following Justice O’Connor's report. One of the causes of the Walkerton tragedy was the privatization of the municipal water testing system. (Oddly, Mike Harris today chairs a private retirement homes company in Ontario, an area where the deadly COVID-19 epidemic toll is tragic.)

Let us not even mention the 2019 budget cuts by Premier Doug Ford to the municipal public health programs in Ontario.

Incidentally, during the 2003 SARS crisis, it is the local municipal public health services that managed the crisis and saved the day, under the leadership of Dr. Sheela Basrur, the medical officer of health for the City of Toronto at the time.

COLLECTIVE MEMORY LOSS

No intention here to point the finger at this or that political stripe, but just to point out how the prevention dividend can prove to be very profitable. And to underline how it is our whole society that seems to have a major memory loss problem.

And yet ... The data is here.

As recently as last year, in 2019, Public Health Ontario released compelling figures on the cost of chronic disease factors. The annual economic burden is $ 7 billion for smoking; $ 4.5 billion for alcohol consumption; $ 2.6 billion for physical inactivity; $ 5.6 billion for unhealthy eating. That is close to $ 20 billion in total.

So how can we learn from these collective memory lapses?

POST-COVID 19: LEST WE FORGET

Hopefully the post-COVID-19 will mark a comeback of this type of economic, political and social analysis.

Hopefully this frame of mind, this way of thinking, will then go beyond the field of health promotion and of public health, to reach into public administration, economics, politics. And, who knows, at the same time, the two solitudes of knowledge will reunite: the natural sciences and the social sciences, as health promotion is deeply multidisciplinary. Starting with the universities that train the decision-makers of tomorrow.

Because yes, an ounce (30 grams) of prevention is worth a pound (454 grams) of cure.

Or in other words, this means 15 times greater expense, later, downstream. That is a return on investment 15 times the original funding upstream.

This basically equals to a prevention dividend of… 1,500 %.