Promoting Health by Tim Veater.
For a leading medical academic to start a piece with the words, "Britain is an increasingly sick nation" (See below) is a sobering thought indeed. However from his article, it is clear Sir John Bell thinks more clinical and surgical interventions are required, not less, and gives scant regard to correcting the underlying societal and behavioural causes of 'disease', or that modern medicine itself may be contributing to the problem.
A long time ago when I was involved with the Health Education Council, I promoted preventative health. It is a good principle that has been characterised as 'stopping people falling in the river rather than just pulling them out'. However, how it is achieved is open to discussion.
It always starts with identifying and analysing the causes of 'disease' and premature ill health and death. We should be aware that initiatives in this area of public policy possess dangers as well as desirable outcomes.
Modern medicine has deeply entrenched beliefs and associations that determine its approach to health. Significantly its dependance on the pharmaceutical and health provision industries, can also be counter-productive to the stated aim - the Covid policy and vaccine roll-out being a case in point. The danger is that priorities are shaped not by efficacy but by the ability to make money.
There is definitely a vested interest in making people ill, rather than preventing it. 'Iatrogenic disease', i'e. that caused by medical intervention, is a significant issue in the overall picture, and the more innovative procedures are promoted, the greater the problem it is likely to be.
Of course nothing changes the fact that the predominant factors in health outcomes relate to life-style, environment, social and genetic factors which all have their own peculiar features. Overwhelmingly, as has always been the case, health and poverty are inextricably linked, although the relationship is far from linear or straightforward. However any policy that does not factor it in, is doomed to failure.
See also:
https://veaterecosan.blogspot.com/search?q=NHS
https://veaterecosan.blogspot.com/search?q=doctors+drugs
https://veaterecosan.blogspot.com/search?q=health
From our friend, Sir Tony Blair's 'Institute for Global Change.'
Leading with ambition and optimism
PUBLIC SERVICES
Moving From Cure to Prevention Could Save the NHS Billions: A Plan to Protect Britain
Regius Professor of Medicine, University of Oxford
"Britain is an increasingly sick nation. The multiple decades of extending life expectancy are over. The health gains from modern medicine have plateaued. We are living longer but not necessarily longer and healthier. By the time a person is 75, they are 60 per cent more likely to possess two or more significant conditions. This figure increases to 75 per cent for those between the ages of 85 and 89 years old.
This presents the health system with a serious demographic challenge. The impact of multiple chronic diseases and comorbidities has brought it to its knees. The NHS operates using a model developed in the last century, focused predominantly on treating late-stage symptomatic diseases with almost no cures and putting very little effort into preventing disease or managing disease in its asymptomatic phase. We are, as a system, shooting at the wrong target.
We know now due to advances in biomedical and clinical sciences that 80 per cent of the natural history of major chronic disease is in the presymptomatic phase. Early intervention can dramatically halt disease progression before irreversible damage is done. We all live most of our lives in a miasma of risk factors – raised cholesterol, hypertension, increased body mass – but only in later life do the diseases propagated by these factors emerge as symptomatic disorders: heart attacks, strokes, diabetes, dementia. The current system has not established the necessary early detection and demand management to prevent end-stage disease.
We are treating disease too late and, as a result of pent-up demand, our NHS cannot cope. We have a sustainability crisis in health and a drag on the economy with large numbers of individuals out of the workforce because of chronic disease. Economic growth and productivity are both being severely damaged by chronic ill health, not to mention the levels of individual suffering created by this problem.
The good news is we now understand the problem far better than ever before and innovation in diagnostics and therapeutics, along with new public-health policies, can change this worrying trajectory. Simple health screening will identify individual risk factors such as low-density lipoprotein (LDL) cholesterol, blood pressure and BMI for cardiometabolic disease. Circulating tumour DNA (ctDNA) blood tests will allow us to identify cancer early. Genomics and artificial intelligence (AI) will help us understand the lifetime risks carried by individuals in order to create personalised prevention plans.
Proactive early detection will require early intervention. Alongside existing solutions, we have a new generation of long-acting therapies that can be used to manage risk factors such as cholesterol and blood pressure based on annual injections, effectively vaccines for heart disease and stroke. Inclisiran alone could prevent 55,000 heart attacks and strokes,
while treating someone for five years after they have a stroke can cost the NHS as much as £45,000.
And, for the first time, we have a new set of therapeutics that will help us tackle the biggest of all risk factors, obesity, which alone costs the country nearly 4 per cent of its GDP in illness and losses in productivity.
Reducing the burden of chronic disease will have profound impacts on society and will importantly save the NHS, allowing it to focus on the treatment of acute and rare disease. People are living longer but spending more time in ill health, often with more than one condition – demand on the NHS has never been so high. As of September 2023, there were a record 7.77 million people waiting for NHS treatment.
This is why it is also important to proactively manage adult infections that can be mitigated using vaccines. We have effective vaccines and interventions for many diseases and, if adequately deployed, these could reduce instances of disease and prevent hospital admissions. For example, there were 40,500 fewer GP consultations for shingles-related disease and 1,840 fewer hospitalisations in the first five years of the national shingles programme.
There is even emerging evidence that vaccines for flu have positive cardiovascular outcomes
and vaccines for shingles can potentially reduce the risk of dementia up to 20 per cent.
Simply put, we have the tools but have not yet put them to proper use.
As elegantly described in this paper, there are good ideas about how to make the most of these tools. Solutions lie in a model that focuses on early detection and early therapy as well as anticipating disease with targeted prevention. Such a strategy would create a genuine “health system” rather than a “sickness system”, which we operate now.
The principles laid out in the coming pages are critical. First, the new system for prevention must work outside but alongside the NHS, which must prioritise fixing other challenges in treatment waiting lists and acute care. Second, this needs to be convenient and accessible, digitised and community based. It requires few doctors and little physical infrastructure. As we showed in the pandemic, the capability to deploy injectables and vaccines at scale in the community can be done efficiently and at speed with digital systems and trained health associates. Third, effective communication with the public about how to proactively protect their health is essential. This must be the future of health care in Britain, and this paper creates an initial example for a roadmap for how it could happen." END
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