Lessons from preventive health approaches

You may know the saying ‘prevention is better than the cure’, but did you know this wasn’t always a commonly-held view? In the past, illness was viewed with a degree of resignation and helplessness and limited public actions were taken to deal with it. Preventive health approaches have developed over the last 150 years. This is due to public policy initiatives that were based on strong scientific advancements. As the evidence base grew for the impact of public health interventions, the mindset towards disease control shifted to new possibilities and public responsibility to take action. There is now a wide acceptance that prevention-focussed health policies will lead to improved health outcomes, reduced costs for individuals and governments and reduced strain on public services.

There are a range of private sector entities working alongside government to drive the preventive health agenda. For example, the Prevention Institute in the USA focuses on building prevention into key policies to foster health, safety and wellbeing. The Institute has developed the ‘Spectrum of Prevention’ which outlines the 6 activities that should be key design features of effective prevention approaches:

• Influencing policy and legislation.
• Changing organisational practices.
• Fostering coalitions and networks.
• Educating providers.
• Promoting community education.
• Strengthening individual knowledge and skills.

The Institute notes that these approaches should include a range of complementary initiatives and expand beyond education campaigns. Australia has a similar prevention-focussed body – the Australian Prevention Partnership Centre.

Why the Commonwealth Fraud Prevention Centre is talking about preventive health

Preventive health policies and programs have been in place for decades and there are many lessons that counter fraud teams can learn from the experience of preventive health campaigns. This article briefly examines 3 case studies of preventive health initiatives, and considers lessons that can be applied in a counter fraud context:

1. Cultural change takes time.
2. Early intervention is a form of prevention.
3. We need to convince individuals to take action.

Lesson 1: Cultural change takes time – prevention is a marathon not a sprint

Australia’s sun safety campaign started in 1981 and 'Slip, Slop, Slap' has become an iconic feature of the Australian summer. The key focus of this campaign is prevention through awareness raising. The campaign consists of repetitive clear messaging that has been going for over four decades. The campaign song also has been updated to include ‘Seek and Slide’. The campaign is credited with successfully changing social norms, attitudes and behaviours relating to sun protection in Australia – but it took time. A lot of time. Compared to habits prior to the 1980s, Australians are now highly sun-aware, but there is still a long way to go in preventing illness and death from sun-related cancers.

All counter fraud officials should take this into account. We aren’t going to solve fraud in a year. It isn’t really something that can be solved or removed entirely. The fraud triangle shows us that as long as the right pressures and circumstances exist for people to commit fraud, fraud events will continue. But, don’t let that crush you. Instead, let it drive and empower you to think big, seek opportunities for innovations and remember that we are in this for the long haul. Change takes time. Every dollar that we can save being lost to fraud is money that can go towards its intended purpose – achieving government outcomes to support the Australian community.

Lesson 2: Early intervention is a form of prevention

The Australian Government’s National Bowel Cancer Screening Program and the National Cervical Screening Program have a very clearly defined purpose: to reduce deaths from cancer by detecting the early signs of the disease. The campaigns are not trying to stop bowel or cervical cancer from ever occurring, that would likely be impossible. Instead, they have established early warning markers that may indicate a developing issue. If these warnings are acted on, this detection-focused approach can prevent a more serious issue in the future. This will lead to improved health outcomes for Australians, and reduce the cost of interventions for the Australian Government.

We can learn a lot from this approach through a fraud lens. Fraud prevention needs to be two‑pronged. We should, of course, try to create policies and programs that build appropriate fraud countermeasures into the design. But, we must acknowledge that fraudsters are adaptable and agile and will likely find new ways to commit fraud against the government. This is why detection and early warning signals are a critical component of fraud prevention approaches. We need to actively look for potential fraud, learn from what we find and adapt our approaches. As a result, we can prevent fraud events from becoming a costly problem.

This message also relates to 2 of the key principles of the International Public Sector Fraud Forum:

• There will always be fraud.
• If you can’t find it, you can’t fight it.

Since we are about positive reinforcement, let’s flip that message to ‘if we can find it, we can fight it’.

Lesson 3: We need to convince individuals to take action

The World Health Organisation (WHO) recognises that behavioural factors play a large impact in the success of prevention activities. For example, in their 2011 article on water, sanitation and hygiene interventions, the WHO concluded that:

"While water, sanitation and hygiene interventions are potentially highly efficient, their effectiveness in part depends on behaviour change and context. The installation and functioning of water and sanitation facilities need to be accompanied by the transfer of knowledge on how to use them, together with sustainable behaviour change."

For health prevention policies to be successful, the campaigns need to convince people to take action. And that’s a key message to keep in mind in any prevention policy – guidance and structures can be created and distributed, but ultimately you will need to convince individuals to take action and keep taking action. We need to create compelling narratives and plan activities around embedding the desired practice – prevention policies must plan for a transition into ongoing action instead of a ‘set and forget’ mindset.

Our approach

Fraud against the Australian Government is a complex problem, and defining the problem was the first step that we took when designing our work plan for the next 4 years. We identified the key problems that were hindering the Government’s efforts to effectively counter fraud. Contact us for a copy of the counter fraud problems. This will help us to have the maximum impact in the next 4 years by focusing our efforts on developing projects and designing solutions that work towards resolving the counter fraud problems faced by the Australian Government.

To make sure we are delivering holistic solutions, we have adapted the Spectrum of Prevention (Figure 1). We will use it to identify future projects and map our impact.

Figure 1: The Commonwealth Fraud Prevention Centre’s Spectrum of Prevention

Adapted from The Prevention Institute, USA.

In the coming years, we will:

• help stakeholders prevent fraud by influencing policy, program and legislation design
• change organisational practices by embedding improved capability in areas such as fraud risk assessment, pressure testing and data analytics
• educate and equip counter fraud practitioners by providing accessible guidance and learning and development pathways
• maintain a strong focus on creating compelling narratives by delivering free workshops to you and your staff on request.

We also have guidance and frameworks already available on pressure testing and countermeasures.

Our call to action

In the past 2 years, only one-third of Australian Government entities reported finding fraud. The UK public sector actively looks for fraud and reports much higher rates of detected fraud which increases every year. This suggests we could do a lot better at detecting and diagnosing the problem.

We would like to issue a call to action: What can you do to find more fraud? What preventive action can you take to deter and detect any issues before they grow? What proactive steps can you take to discover undetected fraud that is, like an undiagnosed ailment, potentially harming your programs and your entity?

We are looking forward to working with stakeholders to identify leading practice, create guidance and help entities to embed new techniques to prevent fraud. One thing is sure: we need to influence a culture that recognises, much like the cancer prevention campaigns, that detecting fraud is a good thing.

Contact us if you would like to engage with us on any of the projects or workshops.

Author: Deanne Allan