Nearly every country produces maps and figures of the unequal distribution of health problems. Rural areas often have poorer health than metropolitan areas. Western Sydney fares worse than the north shore of Sydney. Eastside Vancouver is worse than other parts of Vancouver. Glasgow is worse than most of Scotland. The health atlas idea has truly caught on.

But the idea needs to be put to better use. Instead of simply mapping the unequal distribution of health problems, we should be mapping the unequal distribution of known effective preventive solutions. That might create a missing driver in a health system — public interest and demand for prevention.

Prevention is still seen by many people as the “nice to have” extra after as much as possible has been allocated towards the greedy health care treatment system. But in the last 20 years, the science of prevention has advanced a lot.

Prevention has moved from “nice to have” to “got to have”. We can start taking advantage of the fact that for fifty percent of the risk factors for the health problems that kill us, there are strong preventive programs that work. And why wouldn’t we, if we are truly committed to reducing spiralling health costs?

Preventive program and policies vary in their effectiveness, but with the zero accountability framework we have right now, the public simply does not know whether they are beneficiaries or not.

A falls prevention program for the elderly in one city, for example, could be delivering a 42% reduction in falls among those most at risk (that’s one of the best results known), but if you live somewhere outside of that radius, you miss out.

Your kids could be at schools where drug education programs are ineffective (an estimated $750m per year in the US is wasted that way). Worse still, your kids could be at schools where the drug education curriculum is known to cause more harm than good.

My colleagues and I have put forward a four step plan to reorient a health system more towards prevention, starting by mapping the current distribution of policies and programs proven to increase health — and making the results widely known, say by putting them on a municipal or health region website. This sets up a new type of accountability system.

So much of the talk about making the health system more accountable has been focused on clinical services; it’s time the accountability push broadened its focus.

Putting the public in a position to demand fairness and effectiveness in prevention could quite possibly be an untapped force that could turn our ailing health system around.

*Professor Hawe, an Australian who has been working in Canada for the past eight years, was a keynote speaker at the Sax Institute’s 2008 Health Policy and Research Exchange held in Sydney this week.

Peter Fray

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