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Prioritise and fund prevention to save lives and NHS, warn doctors

Preventable ill-health accounts for about 50% of all GP and 64% of outpatient appointments

Louise Prime

Thursday, 13 September 2018

It is vital that prevention is prioritised and adequately funded to enable the NHS to meet the joint challenges of demographic change, widening health inequalities and increasingly complex long-term conditions, as well as to guarantee its long-term sustainability, the British Medical Association (BMA) insisted this morning. And it also warned that too many people are dying prematurely because of poor investment in public health.

The BMA argued in its latest briefing Prevention before cure: Securing the long-term sustainability of the NHS that the economic case for investment in public health, as well as the health case, “is compelling”. It reported that:

  • Preventable ill-health accounts for an estimated 50% of all GP appointments, 64% of outpatient appointments and 70% of all inpatient bed days.
  • 40% of the uptake of health services might be preventable through action on smoking, drinking alcohol, physical inactivity and poor diet.
  • Healthcare costs increase by 45% for each person with a comorbid mental health problem and long-term condition.
  • Preventable long-term conditions are associated with premature death, in the UK the top five causes of which are: cancer, heart disease, stroke, lung and liver disease. On top of this, in 2017 there were an estimated 3.7 million people in the UK who have been diagnosed with diabetes (90% of which is type 2 diabetes); and the cost of dementia in the UK, the leading cause of death since 2015, is estimated to double in the next 25 years to £55 billion.• Smoking and poor diet account for the highest number of deaths due to preventable disease in the UK (19% and 17% respectively).
  • There is a need to address the factors that influence people’s health behaviours – for example, unemployment and poverty can affect smoking, increased alcohol consumption and decreased physical exercise and are associated with mental health problems and suicide.
The BMA points out that the NHS’s long-term sustainability depends on an evidence-based and adequately resourced approach to the prevention of physical and mental ill-health, so it is calling for improvements in the population’s health (both physical and mental) and reduction in health inequalities to be a central goal of future NHS planning, at both national and local level. It is arguing for policy changes that prioritise and adequately fund ill-health prevention, both within and outside the NHS, to support improvements in population health – for example, investment in services such as smoking prevention.

The BMA is also demanding the introduction of comprehensive regulatory, legislative and educational measures at a national level to tackle key lifestyle factors driving ill-health. It is calling for specific targeted action including: introducing a minimum unit price for alcohol across all UK nations as part of a comprehensive new alcohol strategy; increased taxation on all tobacco products above the rate of inflation; a comprehensive approach to tackling diet-related ill health; greater restrictions on the marketing and promotion of unhealthy food and drink; and adopting a ‘health in all policies’ approach to explicitly consider health in all government policymaking.

Professor Dame Parveen Kumar, BMA board of science chair, said: “It is unacceptable that each year, so many people are dying needlessly from preventable illnesses and long-term conditions such as heart and respiratory diseases, stroke, and some cancers. Tragically, the failure to prioritise public health prevention continues to cost people their lives.”

She added: “Investing in preventative health measures will be beneficial in the long-run; both in the impact on our health and wellbeing and in ensuring the greater sustainability of the NHS. This requires a departure from the short-term thinking that has inhibited progression and a move towards a long-term plan that recognises the importance of prioritising prevention.”

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