New political science analysis of the renewed push for preventive health: 'Can it be any different this time around?'

The idea that 'prevention is better than cure' is often treated as self-evident in health policymaking: who would not want to shift resources from mitigating acute problems to their prevention? However, there is always a gap between rhetorical commitments and practice, producing cycles of enthusiasm then limited progress. If prevention returns to the top of the agenda, how can this time be different? To answer that question, we applied new political science analysis to recent efforts to promote prevention via Integrated Care Systems (ICSs) in England. We theorise persistent barriers to prevention caused by limited: clarity regarding its meaning in practice, congruity with routine policy delivery, and capacity to sustain major changes. We engaged with local and national health and care policy practitioners to explore how these barriers have manifested in practice. We convened seven focus groups (2024) containing sixty participants, then used qualitative thematic analysis to categorise challenges and responses. This approach helped to identify barriers including: short-termism; financial and operational pressures; routine limits to cooperation; untapped community assets; and limited opportunities for peer learning. It also sparked discussion on feasible enablers, including: systems leadership; collaboration to make the wider determinants of health 'everyone's business'; techniques to frame preventive projects as deliverable and evidence-backed; 'institutionalising' prevention; and the better use of data. Paradigm shift towards prevention requires long-term repeated efforts to bolster political support for change and support local collaboration to build and maintain systemic capacity. Political science-driven analysis helps to frame and support this process.