Prevention in the 2020's
Our response to the Department of Health’s consultation paper
When we launched Health Action Campaign we identified four priorities for action - to reduce the risk of avoidable illness in the UK:
- Make healthy choices the easy choices for people – for example by making healthier food and drink more widely available, by increasing opportunities for mental and physical activity and by continued initiatives to make it easier to stop smoking and to keep alcohol consumption to reasonably safe levels.
- More focus on child health – because what happens to us in the early years of life from conception onwards can influence our mental and physical health for years to come.
- Greater support for those at risk – to avoid health inequalities being carried forward from one generation to another.
- A true National HEALTH Service, which gives higher priority to preventing illness, not simply treating it.
It was encouraging to see the Department of Health proposing action in each of these areas, in its consultation paper Advancing our health: prevention in the 2020’s, published earlier this week. Here are some examples from the consultation paper:
Make healthy choices the easy choices for people
‘As a country, we need to eat more fruit, vegetables, fibre and oily fish. We consume too many calories, as well as too much sugar, saturated fat and salt. We know it can be difficult to eat healthily when unhealthy options are all around us. That’s why our focus must be on making healthier choices easier'.
More focus on child health
‘The first 1,000 days of life are a critical time for brain development, and parents and carers have a fundamental role to play in supporting their child’s early development…We must help all children get a good start in life’.
‘We will challenge businesses to improve the nutritional content of commercially available baby food and drinks’.
‘We need to recognise the impact that parental mental ill-health, parental drug and alcohol addiction and domestic abuse can have on a child’s life chances. Providing timely and effective support to help parents overcome these issues, and fostering healthy and collaborative family relationships can have a positive impact on the health of both adult and child’.
Greater support for those at risk
‘We need to take urgent action to tackle the risk factors that can lead to poor mental health, such as adverse childhood events, violence, poverty, problem debt, housing insecurity, social isolation, bullying and discrimination. We also need to invest in the protective factors that can act as a strong foundation for good mental health throughout our lives, such as strong attachments in childhood, living in a safe and secure home, access to good quality green spaces, security of income, and a strong set of social connections.’
‘Where we live has a huge role to play in tackling childhood obesity, whether it is the way our towns and cities are designed to ensure greater active travel or safe physical activity, or how many hot food takeaways can operate near schools….We want to make sure that all local authorities are empowered and confident in finding what works for them to tackle childhood obesity’.
‘There is a clear link between cold homes and ill-health, where existing conditions such as respiratory illnesses or mental health conditions are exacerbated. The government wants all fuel poor homes to be upgraded to Energy Performance Certificate (EPC) Band C by 2030.’
A true National HEALTH Service
‘The NHS Long Term Plan contained a whole chapter on prevention, and set out a package of new measures, including:
- all smokers who are admitted to hospital being offered support to stop smoking
- doubling the Diabetes Prevention Programme
- establishing alcohol care teams in more areas
- almost 1 million people benefiting from social prescribing by 2023 to 2024.’
‘These measures will help to shift the health system away from just treating illness, and towards preventing problems in the first place’.
What else is in the Green Paper?
We fully support much of the analysis and many of the proposals - like the range of action proposed to reduce childhood obesity; the importance of tackling antimicrobial resistance and increasing vaccination rates; the importance of ‘place’ and the role of local authorities in any prevention strategy; the importance of encouraging active ageing; that good work is good for health; and the recognition that improvements to people’s health requires action across government - not just action by individuals themselves and by the Department of Health.
Some proposals are well intentioned but we have reservations about their effectiveness - like an over-reliance on providing personalized health information and assuming that this will be enough to change behavior, when the reality is that the people who tend to act on this information are those who are already more health conscious. This effectively increases health inequalities. Given the influence of peer pressure on our behaviour, we recommend more focus on community based approaches, as a more effective means of reducing inequalities. Once the Brexit situation is resolved and employers can plan with more certainty, we also recommend more focus on what employers can do to encourage Health at Work - as a potential win win for both them and their employees.
Some analysis is excellent and now needs firming up into concrete action – for instance if the NHS is to truly become a National HEALTH service, shifting away from just treating illness towards preventing problems in the first place, then the Department of Health needs to ensure prevention features more strongly in the medical school curriculum and in the continuing professional development of health professionals, that prevention is a more attractive career path for health professionals and that prevention features strongly in Clinical Commissioning Group funding allocations.
Kayhan Nouri-Aria July 2019