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UK falls behind other nations in preventing avoidable death

Smoking, hypertension and obesity behind much of worsening disease burden

Louise Prime

Tuesday, 05 March 2013

The UK is falling behind other high-income countries in preventing premature mortality, shows research published online today in The Lancet. The study’s authors say the UK’s performance, in terms of premature mortality, is persistently below the mean for the EU and “requires additional concerted action”. Health secretary Jeremy Hunt has today announced a ‘call to action’ to combat the UK’s high rate of avoidable death, but GPs have called for individuals to take more responsibility for their health rather than simply expecting government and doctors to sort things out.

Researchers analysed data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and compared the UK’s patterns of morbidity and mortality with those of 18 other countries with comparable health care spending in 1990 and 2010. This group, known as EU15+, includes the original 15 members of the European Union plus Australia, Canada, Norway and the US.

They found a substantial worsening of the UK’s ranking against EU15+ nations for premature mortality rates in adults, especially young and middle-aged adults, over the past 20 years – even though life expectancy has increased by 4.2 years over the two decades. The UK’s top five causes of death have not changed – ischaemic heart disease, chronic obstructive pulmonary disease, stroke, lung cancer, and lower respiratory infections – but Alzheimer’s disease, cirrhosis and drug use disorders have become much more important.

Over the past two decades, the UK has fallen behind the EU15+ average in reducing premature deaths from ischaemic heart disease, COPD, lower respiratory tract infections, breast cancer, other heart and circulatory disorders, oesophageal cancer, congenital abnormalities, preterm birth complications and aortic aneurysm. The UK is also experiencing an increasing disease burden from disability, including lower back pain, falls, depression, anxiety, drug and alcohol use, schizophrenia, and bipolar disorder.

However, the UK did do better than average in reducing premature mortality in just one group – men older than 55 years. And it had significantly better than the EU15+ average premature mortality from diabetes, road injuries, liver cancer and chronic kidney diseases.

The study’s authors said tobacco smoking, hypertension and obesity are responsible for much of the UK’s worsening relative performance, as well as poor diet, lack of exercise and alcohol. They wrote: “Further progress in premature mortality from several major causes, such as cardiovascular diseases and cancers, will probably require improved public health, prevention, early intervention, and treatment activities. The growing burden of disability, particularly from mental disorders, substance use, musculoskeletal disorders, and falls deserves an integrated and strategic response.”

The author of a linked Comment pointed out that the news wasn’t all bad. He said: “Mortality has reduced and several aspects of diet have improved ... The UK has stronger tobacco control than does any other country in Europe, and we continue to enjoy some of the safest roads in Europe.”

But he added: “There is still plenty of room for bold action by politicians and the body politic: plain packaging for cigarettes, minimum pricing for alcohol, banning of trans fats, improved control of hypertension, and attention to psychiatric disorders. Alternatively, the UK can continue to languish at the bottom of European league tables.”

Health Secretary Jeremy Hunt this morning announced his ambition to tackle the top five causes of premature mortality and position England among the leaders of the European league tables for life expectancy. He said: “Despite real progress in cutting deaths we remain a poor relative to our global cousins on many measures of health, something I want to change.

“For too long we have been lagging behind and I want the reformed health system to take up this challenge and turn this shocking underperformance around.”

He said the Department of Health’s cardiovascular disease outcomes strategy, published this morning, will support the NHS and local authorities in improving outcomes for those with or at risk of CVD.

Dr Maureen Baker, a GP in Lincoln and an RCGP Council member, told BBC Radio 4’s Today programme this morning that individuals needed to take some responsibility for their own lifestyle and health, and that it wasn’t all up to GPs – or the Government – to improve people’s health. She said: “We [GPs] do recognise that we have a role in prevention, and we really would like to have more GPs spending more time with patients to be able to take forward some of these prevention and early intervention programmes … [But] there is a huge demand on GP surgeries at the moment.

“Yes there’s a role for the NHS and for GPs [and] for government, but there’s also a role for individuals, for families, for communities – we can’t always expect other people and other organisations to come along and sort things for us.”

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