Quelques idées à propos de la prévention

A few considerations about prevention

Médecin spécialiste en santé publique, 9 rue Émile Durkheim, 75013 Paris, France

Auteur de correspondance : jemmanuelli@free.fr

Résumé

L'objectif de cet article est de réfléchir aux conditions d'efficacité des actions de prévention, en s'interrogeant sur leur limites et en proposant des approches renouvelées pour certaines d'entre elles. La plupart de ces actions se limitent à informer sur un mode rationnel et impersonnel, d'autres tentent de sensibiliser sur un mode émotionnel, comme sur les paquets de cigarettes qui "préviennent" le fumeur de ce qui l'attend. Mais, en l'absence d'intériorisation, les effets de ces messages risquent de s'estomper dans le temps. D'autres actions tablent sur l'approche répressive, qui peut avoir une certaine efficacité. Cependant, un seuil est toujours atteint, imposant le déploiement d'autres stratégies. Pour intégrer la dimension subjective des comportements, une piste pourrait être de s'inspirer des publicitaires pour s'adresser aux profondeurs de la personne. Mais cela, dans un tout autre but, puisque là où la publicité propose de l'objet, la prévention doit proposer du sujet.

Abstract

Our paper aims to analyze the conditions of effectiveness of prevention actions, in particular their limitations, and to propose new approaches for some of them. Generally speaking, these actions are restricted in their majority to messages drawn from epidemiologic reports. Beyond informing, some of these actions seek to reach people on an emotional basis, as on cigarette packages which “warn” smokers of smoking risks (“Smoking Kills”) or TV ads showing the dramatic results of road accidents. However, the impact of such messages may unfortunately decrease over time. Other actions are based on a repressive approach which may be operative, as with the decrease in road deaths due to compulsory wearing of seat belts or the more recent introduction of radar detectors. However, a threshold of effectiveness is always reached after a certain time, which necessitates other strategies. With addictive behaviors for instance, repression, although necessary, cannot alone suppress behaviors due to identity related suffering. Approached from this angle, one aim of prevention might be to create the conditions for a form of questioning that would not judge people, but would concretely face them with their responsibility. To conclude, prevention is not an easy undertaking as the changes it seeks to promote require time and because people will really change only if they agree to do so. In Western societies characterized by mass culture and loss of symbolic references, adopting methods used in advertising to target personal behavior could offer a perspective. The aim would however be totally different since while advertising is designed to sell objects, prevention must propose material to build subjects.