The call for the UK to focus on disease prevention is welcome (UK must focus on disease prevention to save economy and NHS, says expert, July 23). Too many preventive health opportunities are being missed. To be successful, preventive interventions must reach everyone who can benefit. They must be simple and cheap, without unnecessary barriers to access. In general, while individualised medical intervention has a place in the treatment of disease, it is less well suited to the prevention of disease.
Preventing heart attacks and strokes is a significant opportunity. Most heart attacks and strokes occur in people with blood pressure and cholesterol levels that are not considered elevated, while almost all cases occur in people aged 50 and over. For over 10 years, prevention has been possible using a cheap, effective and safe polypill from the age of 50, with no need for any tests or measurements beforehand. Such a polypill, containing a statin and low doses of blood pressure medication, could prevent over two-thirds of heart attacks and strokes, with the full preventive effect achieved around three years after starting treatment. The evidence for this is safe, but unfortunately access is limited to a private service that could mimic the NHS, so that everyone benefits.
Prevention of heart disease and stroke should take a simple, population-based approach. In the absence of a few specific contraindications, everyone aged 50 and over should be offered preventive medication. This would be effective, more cost-effective than a personalised prevention approach and would reduce the pressure on GP practices and the wider NHS. The importance of prevention is now recognised but the method of implementation needs to be urgently reviewed.
Nicholas Wald Professor of Preventive Medicine, UCL
Aroon Hingorani Professor of Genetic Epidemiology, UCL
Prof John Deanfield wants to move disease prevention services into the places where people live, work and socialise to save the NHS. Has he considered how the NHS could work with these people as equal partners in delivering those services? Evidence shows that where people and their communities work together as respected equal partners with the NHS, uptake is higher and the health and wellbeing of communities is improved. This is because many people trust their networks more than the NHS.
There is enough proof that meaningfully connecting with others helps increase people’s confidence to take control of their lives, which improves their mental and physical health, a process known as “health creation”. It also improves their connection to formal health services. Some integrated care systems are now incorporating health creation, partly because of the huge cost of reducing demand on the NHS.
Merron Simpson
Chief Executive Officer, Health Creation Alliance
How refreshing to see the government’s champion of personalised prevention present a bold plan for a ‘pre-NHS’ service. Normalising preventative health checks is good for our health, our communities and our economy. The UK has already seen this happen, from cancer screenings in supermarket car parks to health MOTs in shopping centres. Some employers have also started to play a role, working with local providers to drive uptake.
But with only 45% of UK workers having access to occupational health services, a radical change is needed to encourage employers to do more about health prevention. Some countries, including those in Scandinavia, have successfully implemented models of integrated prevention. Is it perhaps time for an analysis of what the UK could learn and, if appropriate, replicate?
Dr. Karen Michell
Institute for Occupational Safety and Health