The phrase “the ambulance at the bottom of the cliff” describes a situation in which a problem is being addressed the wrong way around, resulting in attempts to fix the consequences of that problem instead of what is actually causing it.
It’s an idiom derived from an 1895 poem by English temperance activist Joseph Malins that tells the allegorical tale of a community debate about whether to build a fence at the top of a cliff that people are regularly falling off or to fund an ambulance at the bottom of the cliff to treat the inevitable injuries after those tumbles.
No doubt Malins was thinking about how many social ills would be solved by banning the demon drink.
Like all good allegories, however, it’s much more widely applicable than the author’s original intent.
I believe it perfectly encapsulates the way our health system is currently organised – and will almost continue to be even after the budgeted $11.1 billion is expended on the system reform the government bizarrely embarked on in the middle of a global pandemic.
The vast amount of the more than $20 billion we spend on health care in New Zealand each year is for the treatment of people who are already seriously ill – in other words, this funding is being tipped into that allegorical ambulance. But what we spend on preventing them from getting sick in the first place – the barrier we still haven’t got around to building – is paltry in comparison, to the point of being non-existent.
To say this seems wrong-headed is surely a heroic understatement. So why is this apparently idiotic approach so entrenched?
As with all things, the reasons are presumably complex. But in very broad terms, it’s because the Western approach to medicine is run as a business, not as a public service.
And what keeps any well-run business ticking over? Repeat customers.
Leaving aside the treatment of physical trauma [caused by, for instance, literally falling off a cliff], which is excellent and improving all the time, the logical business model for those providing medical products – whether they be pills or machines that go ping – is to ensure their treatments keep their customers out of the morgue but ill enough to keep coming back for more.
The vast majority of pharmacological products used around the planet don’t cure anything, they merely alleviate the symptoms of the underlying issue. That’s not to dismiss the importance of having access to such drugs – or to criticise pharma companies for profiting from providing them – but that’s a description of a “just-well-enough” system.
The government continuing to privilege this approach should be a scandal.
According to a 2019 Ministry of Health report, over 80 per cent of the country’s “health loss” is due to “non-communicable diseases”, such as heart disease. More commonly known as “lifestyle diseases”, these are largely avoidable by individuals making some sensible behavioural changes.
So why aren’t we empowering our citizens with good information that enables them to make better decisions about maintaining their health? It’s beyond me, but I do know that I’m sick of the current system.