by Hackney GP Michael Fitzpatrick
The old medical adage “prevention is better than cure” has been extended from infectious diseases to diverse social problems, such as obesity, teenage pregnancy, substance abuse and antisocial behaviour, all supposedly raging at epidemic proportions.
Although the conviction that early intervention yields better outcomes has a common sense appeal, it is only true if the diagnosis is correct and the preventive measures used produce the desired effects (without producing adverse consequences).
But consider obesity and teenage pregnancy. It is by no means clear that the scale of these problems is as great or the consequences as serious as the scaremongers and moralisers who have taken up crusades around these issues seem to believe. Panics about alcohol and drugs, crime and delinquency have come and gone over the years, whether or not there has been a significant recent increase in these problems. The causes are complex and simple solutions are in short supply.
Early intervention is driven by the power of wishful thinking. The notion that there is a window of opportunity before the age of three within which adults can decisively influence infantile development is an old dogma of psychoanalysis now dubiously reinforced by speculative neuroscience. Massive research into Sure Start has confirmed that the evidence for its efficacy is very weak – yet it is stronger than that for any other form of early intervention.
The downside of early intervention is that it pathologises whole communities, inevitably communities that already suffer poverty and neglect.
By replacing family and social links with therapeutic relationships between targeted individuals and professionals, early intervention further undermines personal resilience. Rather than strengthening individuals and communities, it renders them more atomised and more dependent on state support.