• NHS must pay attention to sources of morbidity not just causes of premature mortality
  • Focus must also fall on the preventing conditions not usually seen as a high priority
  • Preventing back pain, mental health problems and skin diseases should help reduce the burden on secondary care

The lead researcher on a landmark public health study has said NHS England must look beyond cancer and heart disease and invest in preventing back pain, skin diseases and poor mental health which are leading causes of ill health.

Professor Nick Steel of the University of East Anglia told HSJ his study, which is being used by NHS England as it develops the NHS long term plan, showed there was a need to focus on less high profile issues as well as “the big killers like heart disease and cancers”.

The study, published today in the Lancet, was part-funded by Public Health England and several PHE officials were directly involved in the research.

In England, the burden of years lived with disability (YLDs) surpassed the burden of Years of Life Lost in 2003. As more people live longer, they “continue to live with long term, often multiple, conditions, and YLDs increase,” the paper explained.

Professor Steel said the NHS has been strong in tackling the major causes of premature mortality but it has not kept up with the shift in the disease burden from causes of mortality to causes of morbidity.

He would like to see the NHS “thinking about giving a higher priority to services for musculoskeletal problems, for skin problems, for mental health problems that traditionally have not been seen as the high priority services.”

“The burden on the NHS from lower back pain is enormous,” he said. “Hopefully the burden on secondary care could be reduced” by actively working to prevent these causes of YLDs.

Professor Steel did not have an answer as to how NHS England could focus both on mortality and morbidity, adding: “I suspect that’s why the NHS plan is very much hoping better primary care will save money” in secondary care.

The study analysed data from the four countries in the UK, taking a more granular view of England. The paper included data on the disease burden across 150 upper tier local authorities.

It showed there was considerable variation in health and life expectancy across England. Increased premature death was aligned closely to people living in more deprived areas. That link was most clear for lung cancer and chronic obstructive pulmonary disease. Both directly relate to smoking rates, which also aligned with levels of deprivation.

“We have had this enormous public health success story in reducing smoking rates,” Professor Steel said. “We’ve had a dramatic reduction in smoking rates” in England “but the benefits of that have not been felt throughout the country.”

“We know that over half of the years of life lost from early death are due to measurable risk factors we can do something about” including smoking, diet and drug and alcohol use.

He hopes this research will enable policymakers at the local level to think more holistically. “We want local government policies and health policies to link in to create healthy environments,” he said.