Since its redefinition in 1974 - before which it included local authority health departments - the NHS has never really taken on a significant preventative role. It is still focused on the treatment of acute illnesses.
In the early years of the NHS, infectious diseases, slum housing and smoky atmospheres were the main health problems it spectacularly solved though its local authority wing. With the realignment of the NHS away from social care, prevention necessarily took a subsidiary role.
This has to change as we are now facing shrinking budgets alongside high public expectations of services.
Promoting knowledge about and adherence to healthy lifestyles is one of the best ways to cut healthcare costs.
With problems caused by obesity, alcohol and smoking increasing every day, it is time the NHS grasped strategic public health leadership to protect and promote the nation’s public health.
The negative effects of obesity and unhealthy lifestyles in general cannot be overstated.
In England, almost two-thirds of adults and a third of children are either overweight or obese; without effective action this could rise to nine in 10 adults and two-thirds of children by 2050. It is estimated that the cost of obesity to the NHS in England in 2007 was £4.2bn and would rise to £6.3bn in 2015.
From my experience as a GP, I would estimate that 50 per cent to 70 per cent of my patients’ medical costs would be not just reduced but eliminated if their diets and exercise regimens were optimised.
It is simplistic and unhelpful to suggest that obesity is caused purely by moral failure of individuals. It is in fact an unintended consequence of modern culture and powerful advertising.
However, we must remember that the average calorie intake of individuals has actually reduced during the obesity epidemic. It is declining physical activity – less walking, less cycling, less PE in schools, less independence for children to play, which has played a major role in causing this epidemic.
The solution lies not just in individuals but also in social and environmental policies. US research showing a six pound difference in mean population weight between pedestrian-permeable and pedestrian-impermeable street designs is one example.
The misuse of alcohol is also responsible for causing severe health problems. There is a staggering 1,000 per cent increase in liver cirrhosis deaths in the 25-44 age group.
The early baby boomers are known as the generation of sex, drugs and rock and roll, and it turns out they are hitting the bottle pretty hard as they age as well. As these mid-lifers become seniors, their excess drinking will cause them serious health problems. Around a quarter of the population drinks to a harmful level, at a cost to the NHS of £2.7bn. This process is fuelled by supermarkets selling alcohol below cost price as a loss leader.
Ironically the pub, which at least combined alcohol intake with social interaction, is in decline as people drink at home with cheap alcohol bought from the supermarket.
Higher rates of alcohol abuse, obesity, and smoking are the reason why people in Tameside will die two years younger than the national average. These health inequalities can be seen even more starkly within the area itself – those in the poorest areas of Tameside will die five years before those in the most well off areas.
Addressing these lifestyle issues should therefore be at the core of any health strategy worth its name. At NHS Tameside and Glossop our initiatives to change people’s lifestyles are having a positive effect. More people than ever before are being helped to give up smoking, and our health improvement teams are working with people to improve their diet and exercise regimes, losing weight and staying healthier. Our progress in this area was recognised by the 2009 HSJ Awards, where we were highly commended for our work on reducing health inequalities in our Bangladeshi community.
I’ve had patients lose weight and stop smoking, and the changes in their quality of life can be dramatic. The issue of life expectancy can seem unimportant in youth and middle age, but immediate health benefits can be felt by those who succeed in giving up smoking and or lose weight – not least the fact that exercise becomes easier and more enjoyable. But we can still only really help those who want to help themselves.
To make greater inroads into public health, more action is needed at central government level. Setting a minimum price level per unit of alcohol and increasing taxation in relation to the alcohol strength of particular products would help reduce alcohol misuse, and the taxes would provide revenue toward the immense cost of the health problems caused by these products. There should also be moves to promote walking, cycling and independent children’s play.
Other steps include urging restaurants to list calorie counts on their menus; open school playgrounds and athletic fields to the local communities; realign bus routes or other transportation to increase access to supermarkets and grocery stores; develop walking and cycling networks, and increase access to free, safe drinking water in public places as an alternative to sugar-sweetened drinks.
Such steps may be seen as radical, and in some cases may be unpopular but legislation against smoking was once seen in the same way. We are facing major problems, and they need major solutions. Without such preventative measures, the NHS bill for treatment of acute illnesses will keep on soaring and our society will be the poorer for it - both in financial and health terms.
Dr Kailash Chand is chair of NHS Tameside and Glossop