American policy, foreign and domestic, is mainly about interventions. Should troops be deployed to intervene in hot zones around the world? How should police intervene in neighborhoods to restore order? Should the government use its economic powers to intervene in the markets, to break up corporate giants, to make workers whole after they are harmed by market failures, to save Wall Street from times of egregious self-indulgence?
No one is arguing problems should not be fixed when they emerge. But every fix is at least a tacit admission of a policy failure — an acknowledgment that a problem was not prevented before it started.
Prevention is not a sexy topic. But almost every great triumph by the American government of the last 50 years has been fought and won by carefully applying sound prevention principles. Fighting enemies and taking a hard line against social ills may win the cable ratings but prevention wins the war.
For 50 years, prevention science has generated practices that have improved countless lives by reducing risk factors and strengthening the conditions for individuals, families and communities to thrive. What distinguishes prevention from reactionary approaches is the focus on using prevention to create new human and social capital. Prevention does not simply put a band-aid on a wound, it seeks to avoid the injury.
And it works. The Centers for Disease Control and Prevention (CDC) has historically issued reviews of public health successes over the past decade and even the past century. Those lists are dominated by prevention victories.
Seat belts, child safety seats, motorcycle helmets, and drinking and driving regulations have made our roads far safer even as they grow more crowded. The food we eat contains vastly fewer contaminants and is more nutritious. Family planning and contraception have reduced infant, child and maternal death by 90 percent since 1900. Teen pregnancy has significantly decreased. And workplace deaths have declined by more than 40 percent just since 1980.
Today, our water is, for the most part, clean and safe to drink and smoking, tuberculosis and HIV are increasingly rare. You have probably never heard of rickets, goiter, pellagra, pneumoconiosis, and silicosis and the very idea that you might contract cholera or typhoid is laughably farfetched. A century ago, these were all common problems. And, as children of the 1970s, we recall rates of tooth decay that were far higher than our children and grandchildren experience today.
We have accomplished a great deal through prevention and learned an enormous amount about how to leverage these tools to achieve even more. Many of the next generation of important prevention policies are on the table right now and form the core of the Reconciliation Bill.
At the top of the prevention priority list is improving academic and behavioral outcomes of our youth with the development and promotion of positive and supportive school environments.
There is strong evidence in the prevention science literature that identifies programs and practices that lead to healthy child development. These evidence-based activities include disrupting pathways to substance use, abuse and addiction across the lifespan; increasing resilience, social competency and self-regulation to reduce impulsive, aggressive and off-task behavior; and supporting healthy relationships and strong families to reduce interpersonal and domestic violence.
Policy approaches that facilitate and amplify these strategies include the Child Tax Credit, improving access to high-quality childcare, paid family and medical leave, greater access to better childhood nutrition programs and routine and preventative healthcare.
Each of the prevention programs listed here is backed by rigorous, transparent and objective research. And, with just a little patience, each of these strategies promises to return far more in benefits to our family and neighbors than it costs for the upfront investment. Indeed, the evidence is so strong, there is little opposition to any of these ideas.
The challenge, of course, is that even if the benefits are large and self-sustaining, the costs must be paid now. In the midst of this historic debate on prevention, perhaps it is time to reorient what we mean by the social safety net. With an investment in prevention, the safety net becomes much more than simply a way of protecting the most vulnerable — it becomes an investment in our collective future.
Prevention is an investment in opportunity and the opportunity is now.
John K Roman, Ph.D. is co-director of the National Prevention Science Coalition to Improve Lives and Senior fellow at NORC at the University of Chicago. Diana Fishbein, Ph.D. is the co-director of the National Prevention Science Coalition to Improve Lives and a senior scientist in the Frank Porter Graham Child Development Institute at the University of North Carolina, Chapel Hill.
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