Opinion

Has the pandemic taught us the value of prevention?

Many of us grew up with the adage that “an ounce of prevention is worth a pound of cure.” Over the past 15 months, the urgent need for prevention strategies and the effectiveness of prevention have been front and centre in the media and in messaging from health experts and government leaders.

The simplicity of these strategies – wearing a mask, hand washing and physical distancing – belies the magnitude of their effectiveness in helping to “crush the curve” while vaccines were in development. They remain effective ways to reduce the spread of COVID-19.

Prevention is the raison d’être of public health but, compared to acute care, it’s not as well funded. It never has been. It would be reasonable to think that, given what we have lived through with COVID, prevention would have risen in priority as a strategy that we, as a society, would embrace.

So far it hasn’t.

Prevention reduces death, hospitalization and emergency-department visits – all of which cost Canadians billions of dollars in financial and human resources, not to mention the human suffering and loss.

On July 5, Parachute, a national injury prevention charity, released the Cost of Injury in Canada. The data show the costs of not investing in prevention: $29.4 billion in one year.

To put that in perspective: According to Statistics Canada, injury was the leading cause of death by far for people ages 1 to 44 in Canada in 2018:

  • Injury: 5,189
  • Cancer: 1,648
  • Heart disease: 605
  • Chronic liver disease and cirrhosis: 245

Shocked? I’m not surprised.

Disease and treatment receive boatloads more attention and funding: We perceive them as a greater threat to our health than injury. But while disease research and treatment is vital and important, so too is preventing injuries.

Historically, investments are made in the acute care sector of the health-care system. Yet, over one year, deaths from preventable injuries resulted in 333,971 potential years of life lost.

Unlike the majority of chronic diseases, injuries kill people at a young age, stealing them from their families and friends and removing them from contributing to society. To fulfil Parachute’s mission to help Canadians live long lives to their fullest, we need to prevent injuries that cause death and serious injury.

Our Cost of Injury Report reveals that, in one year:

  • 17,475 Canadians died;
  • 61,400 Canadian suffered disabilities, temporarily or permanently impacting their potential for economic independence;
  • 231,530 Canadians were hospitalized;
  • 4.6 million Canadians visited an emergency department;
  • The Canadian health-care system was charged $20.4 billion in direct costs;
  • And Canadians spent $29.4 billion in total economic costs. That’s $80 million per day.

We spend money in hospitals to deal with injuries, paying for staff and services. Those resources could be allocated to other needs in the system.

The fact is, virtually all of these injuries and deaths, and the resulting costs, could have been prevented. We know how – wear life jackets, design roadways so cyclists, pedestrians and drivers are safer, install grab bars in all bathrooms (it’s not just for seniors) – but will we? Have we – policymakers, governments, funders, Canadians – really learned the value of prevention? And if so, will we be brave enough to invest in and change the designs, behaviours and systems that create needless, preventable injuries?

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3 Comments
  • Ediriweera Desapriya says:

    I certainly agree with you and thank you for sharing Pamela.
    SARS-CoV-2 can be spread by people who do not have symptoms and do not know that they are infected. That’s why it’s important for everyone to mask in public settings and practice physical distancing (1).
    A new survey suggests the recent rise in new SARS-CoV-2 cases across Canada comes with a similar increase in support for the mandatory wearing of masks in public places. Even more – 87 percent -felt wearing a mask was a civic duty because it protects others from SARS-CoV-2 while 21 per cent felt it was an infringement on personal freedoms (2).
    Early public health preventative measures to control SARS-CoV-2 transmission in Canada were mostly effective and a recent Canadian study found that without any intervention, about two-thirds of Canadians will become infected (3). A recent natural experiment based on two hairstylists in Springfield, Missouri, illustrates the effectiveness of universal masking (4).
    Compelling data now demonstrate that community mask wearing is an effective nonpharmacologic intervention to reduce the spread of this infection, especially as source control to prevent spread from infected persons, but also as protection to reduce wearers’ exposure to infection (5). With the emergence of more transmissible SARS-CoV-2 variants (including Delta variant), it is even more important to adopt widespread mask wearing as well as to redouble efforts with use of all other nonpharmaceutical prevention measures until effective levels of vaccination are achieved nationally (5). Measures to minimize community transmission are urgently needed if we are to save lives and reduce potential unmanageable workload and pressure to our health care system.
    RREFERENCES:
    (1). Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. N Engl J Med. 2020;382(10):970-971. doi:10.1056/NEJMc2001468
    (2). Berthiaume L.-Majority of Canadians say wearing a mask during coronavirus pandemic is a civic duty: poll-https://globalnews.ca/news/7350128/canadians-support-wearing-mask-coronavirus/
    (3). Malecki K, Keating JA, Safdar N. Crisis Communication and Public Perception of COVID-19 Risk in the Era of Social Media. Clin Infect Dis. 2020;ciaa758. doi:10.1093/cid/ciaa758
    (4). Hendrix MJ, Walde C, Findley K, Trotman R. Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy — Springfield, Missouri, May 2020. MMWR Morb Mortal Wkly Rep 2020;69:930-932. DOI: http://dx.doi.org/10.15585/mmwr.mm6928e2external icon
    (5). Brooks JT, Butler JC. Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2. JAMA. 2021;325(10):998–999. doi:10.1001/jama.2021.1505

  • Adelaide Bruchert says:

    What we perceive as preventive may not in fact be effective. Hand washing and mask wearing have been touted as the most effective ways to prevent the spread of viruses, when in fact the data is scarce and incomplete. In surgery, masking and hand washing have proven to be highly effective against bacterial infection. This may not be the case in normal viral transmission. What we do know however, is that ample research exists showing the value of sleep, exercise, nutrition, and weight control, in boosting immunity to prevent or minimize the effects of viruses altogether. But unlike handwashing, these all require considerably more effort which most people find too tedious to bother with.

    • Jane C says:

      Masking & keeping ones hands clean DO impact the transmission of viruses, too. One reason I think people who spit on sidewalks, and/or evacuate their nose onto sidewalks should be charged with endangering the public. I don’t care if its “cultural” or not. It’s unhealthy & disgusting.

Author

Pamela Fuselli

Contributor

Pamela Fuselli is president and CEO of Parachute, a national charity dedicated to injury prevention.

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