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Blog: 'Not enough time is spent debating health'

Blog: 'Not enough time is spent debating health'

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Public Health England’s director of strategy, Jonathan Marron, says the NHS is too busy focusing on the failings of hospitals to actually improve health

The NHS is never far from the headlines. Quality of care, access to out of hours services and troubled hospitals fill the newspapers and drive national debate. Yet for all the discussion of hospitals, we devote far less time to debating health, and what we can all do to improve health and wellbeing. Changing this, shifting the focus of the debate onto health, aligning priorities and resources to support healthy choices, prevention and early diagnosis, will be the key to both a healthy country and a sustainable NHS.

We have a great opportunity to do this. We know the causes of early death and ill health, both in terms of disease and the underlying contributors. From studies like the Global Burden of Disease, published in The Lancet earlier this year and co-authored by Public Health England, we know that smoking, hypertension, diet, exercise and alcohol are the greatest individual risk factors. The reforms to the health and care system provide a great opportunity through the resources of local governments and their new statutory duty to improve health. For CCGs, working with local government through Health and Wellbeing Boards, there will be new opportunities to shape local services to support the health of local people and communities.

Some of this will mean rethinking what we do. Let’s take hypertension as just one example: according to the Quality Outcomes Framework registers there are seven and a half million hypertensive people in this country. Modelling suggests it could be twice that. That’s as many as fifteen million people at risk of the diseases that can result from hypertension, such as stroke, heart disease and kidney disease, half of whom we haven’t identified yet. What if, rather than waiting for these people to present with disease and treating that, we used programmes like NHS Health Checks to find them? Then, rather treating the stroke or heart disease, we could tackle the hypertension with diet, reduced alcohol consumption, exercise and lifestyle changes or, if those aren’t effective, through medical intervention. On available evidence, we could cut stroke rates by up to half.

Simple, early interventions like this at the commissioning level will make the difference. For our part, Public Health England will lead at a national level and provide expert support at the local level. We will get people talking and thinking about the public’s health, to create an environment receptive to these kinds of programmes. We will collect the data and make it available to everyone who needs it. Finally, we will find out what works, what gives the best return on investment, and we will support you in doing it.

Improving the public’s health is our common goal. Working together, we can deliver the right interventions to the right people at the right time, and make that goal a reality.

The full version of this article will be available in the autumn issue of The Commissioning Review. Don’t miss out – subscribe here

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