Since prevention is better than cure, do we invest enough towards prevention strategies in New Zealand?

Prevention is better than cure. Successive policy makers and healthcare providers have recognised this reality. Yet, most have failed to prioritise prevention. Priority needs to be given to interventions and diagnostics with the greatest chance of the largest equitable effects. But which are they and how are they most effectively introduced?

Long-term conditions are now the major challenge for the New Zealand health system. Two in every three New Zealand adults have been diagnosed with at least one long-term condition and long-term conditions are the leading driver of health inequalities. The predominance of modifiable risk factors such as physical inactivity, obesity and tobacco consumption have continued to fuel the rise of long-term conditions.

Whilst we have made great progress in helping people live longer lives, too many of these extra years are spent in poor health. Predictive prevention is one approach that has been explored. While it can increase people’s motivation to change, they have minimal impact on how people actually behave. As attested by almost a century of evidence from the psychological and behavioural sciences, much of our behaviour is shaped more powerfully by the multiple, overlapping environments in which we live; physical, economic, social and digital.

A healthcare “value chain” is triggered when screening, or the suspicion of disease, leads to the application of a diagnostic test. The information obtained from the test may provide more certainty about the best course of action and thus improve patient management. It may lead to further testing or, on the contrary, to no further action. It may also lead to treatment, or to a better choice of the most effective treatment for a specific patient.

Unlike therapeutics, for which direct clinical effects can often be straightforwardly demonstrated, diagnostics provide information that indirectly influences patient management as well as the economic efficiency of healthcare systems.

Health systems seek to address patients’ unmet health needs for a range of acute and chronic diseases. Simultaneously, governments strive to keep healthcare spending sustainable and provide equal access to high quality care.

This has fuelled debate around what constitutes a valuable healthcare intervention in a health system and the corollary consideration of what governments are willing to pay for a certain health intervention. Even though high-quality, reliable information is a key enabler for effective, efficient and patient-centered healthcare, the value of information in general, and the value of diagnostic information (VODI) specifically, have not been part of the discussion until recently.