Seeing the Wood for the Trees- perhaps?

Preventative Health Measures

The public interest in health has risen within the UK with 47% of the population seeing it as the most important issue facing the UK today (YouGov, 2021. The most important issues facing the country. https://yougov.co.uk/topics/politics/trackers/the-most-important-issues-facing-the-country); no doubt, the recent Coronavirus pandemic has played a part in the increase in health awareness amongst the population. The pandemic clearly highlighted many aspects of the NHS’s footfall, particularly with intensive care units becoming full, the supply of ventilators being short and the opening of several Nightingale hospitals to help the NHS cope with the demand for hospital beds. This has demonstrated the need for change within the UK in both how healthcare is provided and how spending is allocated.

Preventative healthcare deserves to be on the current policy agenda, as it provides a solution to many of the issues currently facing the National Health Service (NHS); having the potential to provide a much more cost effective way of delivering healthcare than the current reactionary methods. Benjamin Franklin famously told fire threatened citizens of Philadelphia ‘An ounce of prevention is worth a pound of cure’, which, although referring to fire prevention, holds the same message when examining healthcare.

Preventative methods have proven to be one of the most cost-effective ways of achieving improved health amongst a population (Goetzel, R., 2009. Do prevention or treatment services save money? The wrong debate. Health Affairs, 28(1), pp. 37-41). In the US for example, two-thirds of the growth in health spending can be attributed to worsening health habits (Honig, P. & Terzic, A., 2017. Affairs of the Heart: innovation in cardiovascular research and development. Clinical Pharmacology & Theraputics, 102(2), pp. 162-168). An example of overspending due to poor health habits in the UK would be the current obesity crisis. Obesity is an example of a disease caused by bad health habits that can result in many other illnesses such as, diabetes and coronary heart disease; resulting in the NHS’s resources being taken up by complications caused by these diseases. In 2015, obesity-related ill health cost the NHS ￡6.1 billion and is estimated to cost the NHS around ￡9.7 billion a year by 2050 (Public Health England , 2017. Health matters: obesity and the food environment. https://www.gov.uk/government/publications/health-matters-obesity-and-the-food-environment/health-matters-obesity-and-the-food-environment--2). The cost has soared from ￡58 billion in 2020 to ￡98 billion, according to the Tony Blair Institute. The costs to people affected rose from ￡45.2 billion to ￡63.1 billion a year, and the costs to the NHS from ￡10.8bn to ￡19.2bn, according to modelling undertaken for the thinktank by Frontier Economics. The biggest proportional jump came in costs to society as a whole. These have risen more than sevenfold, from ￡2.1 billion to ￡15.6 billion, mainly from lost productivity because a record 2.4 million people are now too sick to work, often as a result of being overweight or living with obesity.

Furthermore, preventative healthcare can benefit both society and the economy as a whole, not just reducing pressure on the NHS. When looking at economic growth, the Harrod-Domar model takes into account the role of the workforce and its contribution to economic growth. A healthier workforce has a greater productivity and thus the economy grows, which is beneficial for all (Solow, R. M., 1956. A Contribution to the Theory of Economic Growth. The Quarterly Journal of Economics , 70(1), pp. 65-94). Ill health subtracting from the economy and affecting society negatively. Returning to the example of obesity, this disease cost the wider society in the UK ￡27 billion during the period of 2014-25 (Public Health England , 2017. Health matters: obesity and the food environment. https://www.gov.uk/government/publications/health-matters-obesity-and-the-food-environment/health-matters-obesity-and-the-food-environment--2). The negative impact that poor health can have on both the health service and wider society, demonstrates a policy gap that can be filled and built upon by preventative healthcare policies.

However, despite this, it seems that there are several reasons why preventative health measures are not high up on the current agenda of policy makers. Many of the population are satisfied with the current healthcare system; McKee argues that change is not needed as the system performs well by international standards (McKee, M., 2012. Does anyone understand the government’s plan for the NHS?. BMJ, 344(399)). Subsequently, the issue and necessary policy change never reaches a big enough audience to gain traction in the public arena. Kingdon sets out that public opinion makes up part of three streams necessary for a problem to be addressed (Kingdon, J. W., 2011. Agendas, Alternatives, and Public Policies. 2nd Edition ed. Boston: Longman). Thus, if public attitudes are in favour of current policy solutions, no new solutions can come to the forefront.

Even the recent pandemic, which highlighted many of the problems with the NHS and brought a call for policy change didn’t have a lasting effect. The third stage of the issue attention cycle states that a populations realisation of the cost of significant progress can result in a drop in the focus and desire for policy change to occur (Downs, A., 1972. Up and Down with Ecology - the Issue-Attention Cycle. The Public Interest , Volume 28). With regards to healthcare, many people like the initial idea of changing diet and increasing exercise, but many lose desire and motivation after realising the length of commitment needed for lasting results.

Consequently, policy makers in the government are merely motivated to continue as they have done before. Recent governmental budgeting demonstrates this, announcing that the Department of Health and Social Care’s spending estimated to rise to more than ￡177bn by 2024-25 (Triggle, N., 2021. Lots of Money for health - but what about staff?. https://www.bbc.co.uk/news/health-59078596 ), continuing the trend of trying to inefficiently buy the health service out of its faults, rather than introduce new policy.???

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Gauging Risk to Health, and the Individuals Right to Freedom of Choice

As we live in a society whose health is addressed by a national health service, I wouldn’t suggest that we follow the guidance of Ronald Regan: ‘Government exists to protect us from each other. Where government has gone beyond its limits is in deciding to protect us from ourselves’, as this would assume that everyone is able to gauge risk equally and adequately.

There are many things in our daily lives that put us at risk, and impact negatively upon our health and life expectancy: not exercising enough, eating too much processed food, drinking excessive amounts of alcohol, carrying too much weight. Likewise, according to the Office for National Statistics, the leading cause of death in the UK in 2018 was dementia and Alzheimer disease, accounting for 12.7% of all deaths registered. From 2001 to 2018, suicide and injury or poisoning of undetermined intent was the leading cause of death for both males and females aged 20 to 34 years in the UK, for all years observed, accounting for 27.1% of male deaths and 16.7% of female deaths for this age group.

Although smoking cigarettes is one of the 12 risk factors for dementia described in the 2020 report of the Lancet Commission on dementia prevention, intervention, and care (Lancet. 2020 8-14 August; 396(10248): 413–446. doi:10.1016/S0140-6736(20)30367-6), the others, particularly those associated with over eating and a sedentary lifestyle, should not be forgotten:

·?????? Low education

·?????? Hearing loss???

·?????? Traumatic brain injury???????????

·?????? Hypertension?

·?????? >21 units/week of alcohol?????

·?????? Obesity (body-mass index ≥30)????????

·?????? Depression?????

·?????? Social isolation??????????

·?????? Physical inactivity?????

·?????? Diabetes?????????

·?????? Air pollution

I must say that a major concern about the phased ‘generational smoking ban’ Prime Minister Rishi Sunak has committed to making law, is that if implemented, this policy will have unintended yet serious consequences to the freedom of the individual, which many do not believe have properly been considered.

In 2008, the leading cause of death for females aged 50 to 64 years changed from malignant neoplasm of breast to malignant neoplasm of trachea, bronchus and lung, which accounted for 10.1% of deaths for this age group in 2018. This is believed to be driven by cigarette smoking amongst women, particularly younger women, and I do believe that the philosophy behind the Health Act 2006 has resulted in a positive impact on the health of the Nation; cigarette smoking, in my view does put the individual at unreasonable risk. However, we should not take things too far and impact on the ability of individuals to make an informed decision to be involved in a hazard that doesn’t significantly put them at risk.

The risk of using tobacco is known to differ between the various types and routes of administration. For example, although the data shows that male cigar smokers age 40?+?years have elevated mortality risks, after accounting for cigarette smoking and other confounding variables, the significantly increased mortality was only among dual and former users of cigarettes (Rodu, B., Plurphanswat, N. Mortality among male cigar and cigarette smokers in the USA. Harm Reduct J 18, 7 (2021). https://doi.org/10.1186/s12954-020-00446-4). Likewise, pipe smoking confers a risk of tobacco-associated disease similar to cigar smoking (S. Jane Henley, Michael J. Thun, Ann Chao, Eugenia E. Calle, Association Between Exclusive Pipe Smoking and Mortality From Cancer and Other Diseases, JNCI: Journal of the National Cancer Institute, Volume 96, Issue 11, 2 June 2004, Pages 853–861, https://doi.org/10.1093/jnci/djh144).

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Potential Opportunities to Address the Obesity Epidemic

If one compares the cost to the UK of the obesity epidemic (described above) to those associated with smoking cigarettes (￡14.07 billion annually: The cost of smoking to the social care system. Action on Smoking and Health, March 2021 https://ash.org.uk/uploads/SocialCare.pdf ), it would suggest to us, if choosing between one or the other, that our time would be better spent addressing obesity.

The promotion of preventative healthcare through policy could take multiple forms that could be introduced separately or as a joint policy strategy. The following suggestions might provide a long-term sustainable solution to improve the health of the population and prevent a reliance on the NHS that could occur if lives continue to become more sedentary.

·?????? Increase taxes on processed food in order to discourage their consumption

·?????? Introduce subsidising of fresh, healthier alternatives in order to make healthy eating more affordable and appealing

·?????? Use social media and similar routes to better educate the population about the importance of diet and exercise and the negative repercussions that can occur, both to individual health and cost to the NHS. This policy would be specifically effective for younger ages; with a third of 10-11 year olds being classed as obese in the UK (Public Health England , 2017. Health matters: obesity and the food environment. https://www.gov.uk/government/publications/health-matters-obesity-and-the-food-environment/health-matters-obesity-and-the-food-environment--2)

·?????? Further subsidising of sport projects and encouragement of the population – especially younger individuals – to exercise more. Exercise is proven to improve not only physical health, but also mental health. Therefore, an increase in accessibility to sport and exercise can massively reduce a cost burden from the NHS

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