Proactive v retroactive thinking

Rishi Manchanda was named as one of the leading healthcare innovators in America by Atlantic magazine.

But he thinks there’s something fundamentally wrong with US healthcare.

He uses an analogy to explain how the system needs to change.

"Three friends are walking by a river, they notice an endless stream of children struggling in the fast-flowing current, being carried towards a waterfall.

"The first friend jumps in and starts pulling out as many as he can, but he only saves a few.

"The second friend starts building a raft to carry more, but she can’t save them all, either.

"The third friend begins swimming away from the waterfall, upstream.

"The other two friends yell out: 'Where are you going?'

"The third friend yells back: 'I’m going to find out why the children are falling in the river.'"

Rishi Manchanda uses that metaphor to illustrate what’s missing from healthcare.

We have doctors and healthcare professionals trying to help those who are already sick.

But we have no-one going upstream, preventing people from getting sick.

My dad was a policeman, he worked in the uniform branch.

I asked him what was the difference between uniform and plain-clothes police.

Dad said it was uniform’s job to prevent crime, it was plain-clothes’ job to solve crime after it happened.

He said uniform’s motto was: "An ounce of prevention is worth a pound of cure."

That’s a brief summation of Rishi Manchanda’s "upstream healthcare" position.

The problem is that we tend to think retroactively not proactively.

Manchanda says that living and working conditions account for 60% of preventable deaths, and environment has five times the impact on health of all pills and procedures combined.

So why is it allowed to continue? Because we prioritise volume over value.

We are hooked on the quick fix, even though it can’t solve the problem.

Which pretty much sums up the way we approach advertising.

There are more and more advertising channels to be filled, every hour of every day.

Every OOH digital-poster site changes every 10 seconds, there are dozens of commercials in an advertising break, there are over 100 TV channels, there are ads every time you click your keyboard, there isn’t time to think upstream, there’s barely time to fill all the space.

We all know the numbers: £20bn spent on marketing and advertising each year.

Of which, 4% is remembered positively, 7% is remembered negatively, and 89% isn’t noticed or remembered at all.

So that’s roughly £18bn totally wasted each year by people who’ve only got time to respond, not to think upstream.

It’s a cliché that advertising should be an investment not a cost, but we don’t treat it like that, we treat it as money that has to be spent, fast.

In China 400 years ago, during the Ming Dynasty, Li Shizhen was a senior member of the Imperial Medical Assembly.

He thought the main problem was that doctors only got paid when people were sick.

So that was the only time they had an incentive to work hard.

He believed it was too late then: "To try to cure disease when one is sick is like waiting until one is thirsty to start digging a well."

He proposed paying doctors when people were well, but suspending payment when they were sick.

That way, the incentive was to concentrate on keeping people well.

Proactive thinking, not retroactive.

If advertising worked like that, we might actually see some upstream thinking.

Dave Trott is the author of Creative Blindness and How to Cure It, Creative Mischief, Predatory Thinking and One Plus One Equals Three

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