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One of the powerful aphorisms in giving shape to the New Public Health in the 1980s was the notion that the world was a fast flowing river, with healthcare workers standing on the banks with white water swirling below. Every so often a drowning person would be swept down and our workers/life savers would jump in, pull them out and resuscitate them. They were so busy jumping, pulling out, and resuscitating, that they had no time to walk up stream and see who was pushing everybody in.
This story resonates with the every day claims of busy clinicians to be too busy to focus on prevention. At the same time, it raises questions about the policies that might keep people away from the river in the first place, environmental measures of fences, warning notices, etc, to keep people from falling or jumping in, lifestyle measures such as swimming lessons and the appropriate balance between early assistance from life guards or later support from emergency ambulances and casualty departments. Without a balanced approach, all the resources could be focused down stream.
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