How preventive medicine could be key to saving the NHS | Letters

The call for the UK to focus on disease prevention is welcome (UK must move towards disease prevention to save economy and NHS, says expert, 23 July). Too many preventive health opportunities are missed. To be successful, preventive interventions need to reach all who stand to benefit. They should be simple and inexpensive, without unnecessary barriers to access. In general, while individualised medical intervention has a place in the treatment of disease, it is less appropriate for the prevention of disease.

The prevention of heart attacks and strokes is a major opportunity. Most heart attacks and strokes occur in people with blood pressure and blood cholesterol levels that are not regarded as raised, whereas almost all cases occur in people aged 50 and over. For more than 10 years, prevention has been possible using an inexpensive, effective and safe polypill from the age of 50, without the need to perform prior tests or measurements. Such a polypill, containing a statin and low-dose blood pressure medicines, could prevent over two-thirds of heart attacks and strokes, with nearly the full preventive effect being achieved about three years after starting treatment. The evidence for this is secure, but unfortunately access is limited to a private service that the NHS could emulate for all to benefit.

Prevention of heart disease and stroke should adopt a simple population-based approach. In the absence of a few specific contraindications, everyone aged 50 and over should be offered preventive medication. This would be effective, more cost-effective than a personalised prevention approach and would relieve pressure on general practices and the wider NHS. The importance of prevention is now acknowledged, but its method of implementation needs urgent review.
Nicholas Wald Professor of preventive medicine, UCL
Aroon Hingorani Professor of genetic epidemiology, UCL

Prof John Deanfield wants to move illness prevention services into the places people live, work and socialise to save the NHS. Has he considered how the NHS might work with these people as equal partners in delivering those services? Evidence shows that where people and their communities work as respected equal partners with the NHS, take-up is higher and communities’ health and wellbeing are improved. This is because many people trust their networks more than they trust the NHS.

There is ample evidence that being meaningfully connected to others helps build people’s confidence to take control of their lives, which improves their mental and physical health, a process known as “health creation”. It also improves their connection with formal health services. Some integrated care systems are now embedding health creation, partly because of the huge prize of reducing demand on the NHS.
Merron Simpson
Chief executive, Health Creation Alliance

How refreshing to see the government champion for personalised prevention present a bold plan for a “pre-NHS service”. Normalising preventive health checks is good for our health, our communities and our economy. The UK has already seen this succeed, from cancer screening in supermarket car parks to health MOTs in shopping centres. Some employers have already begun to play a part too, working with local service providers to promote uptake.

However, with only 45% of Britain’s workers having access to occupational health services, a radical shift is needed to encourage employers to do more on health prevention. Some countries, including those in Scandinavia, have successfully implemented models of integrated prevention. Might it be time for some analysis of what the UK might be able to learn and, if appropriate, replicate?
Dr Karen Michell
Institution of Occupational Safety and Health