… and lack of progress

In some Member States, progress is slow and non evidence-based concepts still prevail. The reasons for this include inertia, an overemphasis on medical and addiction-centred approaches, a failure to appreciate the importance of social influences and a focus on personal variables. In addition, in some countries, a lack of standards means that prevention is solely the remit of local health professionals or teachers, whose knowledge about evidence-based prevention is often low, with the result that prevention is on the level of popular opinions and beliefs. And in some Member States (e.g. Denmark, Estonia, France, Latvia and parts of Belgium, Germany and Italy), school-based prevention is still largely based on information provision through booklets, sporadic seminars, action days and exhibitions, meetings, lectures or expert visits.

There is evidence, albeit limited (Flay, 2000), that successful school-based prevention needs to be embedded in a health promotion curriculum and a school drug policy and that it must address aspects of social life and the community (Paglia and Room, 1999). However, the inflationary use of phrases such as ‘promotion of healthy lifestyles’, ‘holistic approaches’ and ‘integral prevention’ often conceals the absence of a sound basis for prevention policies and a limited commitment to evidence-based prevention. There has been no visible progress in family-based prevention. As a component of universal prevention, family-based prevention remains limited to parents evenings or groups (e.g. Germany, Greece, Sweden), while it forms a constituent of selective prevention (i.e. concentrating on families at risk) only in Spain, Ireland, Poland, Sweden and the United Kingdom (Table 4 OL).

Table 4 OL: Prevention (key parameters)