Now the NHS has turned 70, and with the Government preparing a long-term plan for the service in England, a broad range of leaders in charities and voice organisations have come together to offer our views on what should happen next to improve health and care – within the NHS and beyond.
Prevention and public health
What is the problem?
Chronic disease – particularly cardiovascular disease, cancer, diabetes and chronic lung disease – is the leading cause of death, illness and disability in the UK . Almost half of NHS costs are from diseases related to physical inactivity, smoking and poor diet (including harmful alcohol use),  yet up to 80 per cent of premature deaths from chronic disease could be prevented by tackling these three factors .
Most deaths from chronic disease will be preceded by years of ill health, placing a social and economic burden on people, their families and the NHS. Each year, the UK spends about 20 times as much on treating ill health as it does on preventing it, even though prevention is 20 times more cost-effective on a lifetime basis .
Health care only accounts for around 10 per cent of a population’s health, with the rest being shaped by how and where we live, work and play . Health – and health care – is about more than just changing people’s behaviour. It is inextricably linked with the environments we live in: our neighbourhoods and workplaces; the food sold in local shops; and what health professionals model as healthy behaviour.
Depending on where you live in the UK, your life expectancy can vary by as much as 16 years . From 1965 to 2008, 1.2 million more people died before the age of 75 in North England than in South England, which researchers attributed to ‘persistent inequality’ between the two regions .
Evidence shows health professionals lack knowledge about prevention and often have the least healthy lifestyles. The first prevalence study of its kind – commissioned by the C3-led Healthy Weight Initiative for Nurses – found one in four nurses in England are obese .
What needs to happen?
The good news is that there is a huge amount that can be done to address the risk factors and prevent or delay chronic disease, and the subsequent need for expensive treatment. Three changes to improve people’s health are particularly important in prevention: increasing physical activity; improving diet (including avoiding harmful alcohol use); and stopping smoking.
Health professionals are well placed to give the trusted, accurate advice needed to prevent and treat chronic diseases. NHS England has already recognised the importance of a healthy NHS workforce, both for their 1.5 million employees and as an exemplar to improve the health of the population. By working with health professionals to incorporate healthy lifestyles into their own lives, the NHS can ensure they become credible advocates for their patients, families and communities.
- Staff health and wellbeing should be integrated as core components of service planning, contracts and tenders so that all NHS staff – including those who are employed by third-party contractors – have access to high-quality occupational- health services, evidence-based health-promotion initiatives (such as smoking- cessation support and healthy-eating options), and fair terms and conditions.
- Other parts of the health system – such as GP surgeries, dentists, optometrists and pharmacies – must not be overlooked. They should be involved in efforts to improve the health of their staff and the people they support.
- All staff working in the health and care system should be supported to lead healthy lifestyles at work. This includes (but is not limited to): protected time to take breaks to eat; access to drinking water; healthy, available and accessible food in canteens and vending machines; and dedicated space to store, heat and eat lunch (which is not a room where staff change or where drugs are stored).
Because of inequalities, it is imperative that primary prevention efforts incorporate co-produced community action. Ultimately, incentives need to be in place to make it easier for communities to live healthy, active lives.
- Professionals must engage with communities, especially the most vulnerable, and involve them with the planning and implementation of prevention efforts.
- The built environments surrounding communities must be systematically assessed for the assets and barriers that make it easier or harder to live healthy lives. Community members, guided by public health expertise, should design the health interventions that will be most effective and valuable for their communities.
- Planning authorities, whose history is rooted in public health, should be organised alongside local public health authorities to ensure the health impacts of planning and development decisions are understood and acted upon .
Where is this already being done well?
Eleven demonstrator sites, supported by NHS England, have been working on a range of actions to deliver ‘a core offer’ of what NHS organisations should do to improve the health and wellbeing of their workforce. This programme provides learning for the wider NHS to build upon.
Generating community action in prevention is already taking place in parts of the country. C3’s CHESS™ (Community Health Engagement Survey Solutions) offers an evidence-based approach that shifts decision-making to local communities by engaging them as ‘citizen scientists’ in an investigation about their health and the built environment . Recently completed projects in disadvantaged areas of London and Halifax have engaged up to one-third of the local population in health and community action, strengthened partnerships between local organisations, and led to new and extended health and wellbeing interventions. These interventions include: healthier options in local shops and restaurants; classes on cooking, wellbeing, and gardening; dance sessions; healthy picnic lunches for school children during the summer break; sports, dance and activity sessions; and improved community resilience, confidence, and social cohesion through more developed networks.
What is one priority action that needs to be taken ‘now’?
Too many policies suggest that, with education, people will change their unhealthy behaviour, yet the people most at risk live and work in tough environments. The NHS has to take a lead in addressing inequalities. It must invest in community action that sees community members, particularly the most vulnerable, designing and implementing neighbourhood health interventions that make the healthy option the easy option, for all. And the NHS must ensure that incentives – nationally and locally and across all public bodies – are aligned to tackle the underlying causes of poor health once and for all.
- World Health Organisation (2014). Country profiles. http://www.who.int/nmh/publications/ncd-profiles-2014/en/
- Scarborough, P. et al (2011).The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs. Journal of Public Health, 2011;33(4):527–535 www.ias.org.uk/uploads/pdf/ Economic%20impacts%20docs/pubmed.fdr033.full.pdf
- World Health Organisation (2005). Preventing Chronic Diseases: A vital investment. www.who.int/chp/chronic_disease_report/contents/en/
- Local Government Association (2015). Prevention: A Shared Commitment. https://www.local.gov.uk/sites/default/files/documents/prevention-shared-commitm-4e7.pdf
- Commission on Social Determinants of Health (2008). Closing the gap in a generation. World Health Organisation http://www.who.int/social_determinants/final_report/csdh_finalreport_2008.pdf
- Triggle, N. (2017). Life expectancy rises to ‘grinding halt’ in England. BBC News, quoting Sir Michael Marmot www.bbc.co.uk/news/health-40608256
- Buchan, I. et al (2017). North-South disparities in English mortality 1965-2015: longitudinal population study. Journal of Epidemiol Community Health 2017;71:928- 936 https://jech.bmj.com/content/71/9/928
- Kyle, R. et al (2017). Obesity prevalence among healthcare professionals in England: a cross-sectional study using the Health Survey for England. BMJ Open 2017; 7(12):e018498 https://bmjopen.bmj.com/content/bmjopen/7/12/e018498.full.pdf
- NHS Employers (2018). NHS England healthy workforce programme. www.nhsemployers.org/your-workforce/retain-and-improve/staff-experience/ health-work-and-wellbeing/copy-of-leading-the-way/whats-happening-nationally/nhs-england-healthy-workforce
- C3 Collaborating for Health (2018). CHESSTM tool. www.c3health.org/chess-tool/