Defining Prevention

Annex A – Guidance on Applying Scottish Prevention Unit Definitions

Even when there are clear definitions of prevention, policy makers do not always apply prevention definitions correctly in practice. This can be because:

• the activity under consideration is too aggregate to be meaningfully categorised as preventative or not.
• the intervention may straddle a number of different types of prevention (e.g. being partly primary and partly secondary).
• the activity is not defined in relation to a clear problem(s)/negative outcome being addressed.
• there is limited evidence on the impacts of a particular policy.

To help with applying prevention definitions in practice, we provide a process for helping determine whether an activity is in the scope of our prevention definitions (Figure 4).

Specify the prevention activity

Consider main purpose and target population

Apply prevention definition

Review the evidence

This is a categorisation tool to help people assign policies to prevention based on intent in the first instance, as evidence may not be readily available to make an evidence-based assessment. However, the process also sets out how evidence should be developed to support the definition of prevention activity over time.

More guidance on these steps is provided below.

Step 1: Specify the prevention activity

Our overarching definition of prevention is: activity intended to stop the establishment or escalation of problems that lead to negative outcomes for people.

The key feature of this definition is that it intends to narrow down the focus on particular activities that primarily aim to prevent negative outcomes in future, and to distinguish these from other activity (such as responsive demand).

Therefore, a preventative activity should be specific. If an activity is too aggregate, this will make it difficult to distinguish between what may be preventative vs other activity. For example, defining “the justice system” is too broad to allow for meaningful categorisation and analysis, particularly in terms of defining at what prevention levels the activity sits. However, defining activities within this, such as a programme to prevent first time offenders, allows a much easier categorisation.

Step 2 – Primary purpose and target population

Once the activity has been specified, there are two guides that can help assess whether the activity is preventative, and what level of prevention it is (if preventative). These are:

• The target population – the target population is often sufficient as a guide on the level of prevention for a particular activity. For example, whether the intervention is population-level (which tends to be primary prevention), a smaller sub-set of the population at risk (secondary), or a targeted group who have experienced a problem (tertiary).
• Primary purpose of the policy – we also consider the primary purpose of the policy and whether it aims to stop something happening in the first place (primary), stop the emergence of problems for at-risk groups (secondary), or stop something from getting worse (tertiary).

This framework for identifying prevention is used in the Prevention Unit Preventative Budgeting Guidance, which drew on the established system of classifying preventative investment developed by the Chartered Institute for Finance and Accounting.^[15]

Step 3 – Apply prevention definition

Once you have considered Step 2, this should then point towards where the activity sits within the prevention definition.

Figure 5 shows examples of categorisation between preventative and other types of activity.

Figure 6 shows how these assessments of target population and main purpose can then be used to make an assessment of the level of prevention.

It is often the case that many activities will not be 100% in one type of prevention category (e.g. primary prevention), but rather the activity may be majority one category and have some activity in another category (e.g. 80% primary and 20% secondary). In a simple categorisation, we will tend to categorise within the level of prevention which accounts for the majority of activity within the policy. For more detail and nuance, we suggest splitting the activities out again as in step 1 and repeating the steps.

Step 4 – Reviewing against available evidence

Defining an activity is the first step in analysing prevention. Next, it is typically useful to consider what outcomes will be impacted by the preventative activity, and what evidence exists on the effectiveness of the activity.

The process outlined in this paper is to help policy makers and analysts come up with a quick assessment and conceptualisation of whether their policy or activity is preventative, and how to go about applying concepts of prevention to that activity.

However, over the longer term, evidence to appraise and evaluate the preventative impacts of policies should be undertaken. Based on any evidence developed, your view of preventative activities should be reviewed to understand the extent to which the policy is actually achieving the preventative outcome it is intending to.

Prevention definitions and “grey areas”

Even when prevention definitions are set and clear guidance is provided, it may be that there are still some grey areas that remain.

This can be where it is difficult to split out activities (e.g. it may be difficult to split out the activities undertaken by cultural institutions that aim to prevent social isolation). It can also be that activities straddle two levels of prevention – e.g. both primary and secondary.

The Prevention Unit definitions and guidance have been designed to provide clarity and to reduce these grey areas. However it is likely that any definition will not remove all grey areas. This is because identifying prevention policy is partly subjective and dependent on the ability to disaggregate policies into discrete activities. If the above process does not lead to clean distinctions, then document the potential grey area and discuss why it is difficult to classify. You could explore other techniques, such as apportionment where further information on specific activities are unavailable. This is an approach deployed in the Prevention Unit’s Preventative Budgeting Guidance, for example.^[16]