Much of the advance in population and life expectancy in the last century has been the result of improvements in living conditions and hygiene, and vaccination against infectious disease (see Somerset Annual Public Health Report 2016). Although it is a truism that ‘prevention is better than cure’, emphasis in health policy, certainly since the creation of the NHS, has been on treating illness. The Five Year Forward View sets out that a ‘radical upgrade in prevention is needed to improve people’s lives and achieve financial sustainability of the health and care system’. Locally, this upgrade is visible in the Somerset Sustainability and Transformation Plan which encourages and supports ‘everyone in Somerset to lead healthier lives and avoid getting preventable illnesses’.
Types of prevention
Prevention in health is usually grouped into three categories:
This is made up of activities to reduce incidence of disease, such as vaccination. In its broadest sense it includes improvements to the whole range of factors that affect population health.
This is exemplified by screening for illness, or other activities that promote early detection of illness. Early detection of illness, or of precursors of illness (such as ‘pre-diabetes’) often means that the conditions can be treated more effectively and with fewer unpleasant side-effects and complications.
This comprises actions that prevent the incapacity associated with illness, or to reduce the risk of it recurring. Unlike primary and secondary prevention, this is addressed to people already diagnosed with a condition.
Lifestyle and risk factors
The figures in the pie chart show one assessment of the relative contributions made to health by different aspects of life. It is clear that these factors are complex to define and may overlap – so it is more appealing to take part in physical activity outdoors in a safe society in an attractive environment, for instance – and a classification like this is an oversimplification. Unsurprisingly, there is more than one version of this graph from different sources. However, even though there is a considerable genetic element that cannot normally be changed, the large ‘lifestyle’ element shows how relatively simple changes in behaviour can lead to reduction in risk.
The figure below (click on image to enlarge) shows how the Department of Health has assessed a wide range of factors that can affect individuals’ physical health, and so the overall ‘burden of disease’ at a population level. Almost all the factors come under the headings of diet and exercise (and so obesity, which is closely related to these two), excessive alcohol consumption and – clearly the most hazardous – tobacco smoking. A further contributing factor– loneliness - has gained more recent prominence for its impact on health status, notably mental health, which contributes a further 25% or so of the total burden of disease.
UK health performance: findings of the Global Burden of Disease Study 2010
Prof Christopher JL Murray, MD, et al
Volume 381, Issue 9871, Pages 997-1020 (March 2013)
Implications for Commissioning
The evidence here illustrates the importance of lifestyle factors such as tobacco smoking, drinking alcohol, poor diet and lack of exercise, and lack of social contact, in contributing to the overall burden of ill health and disease. It shows how improving these lifestyle factors in particular can have a positive impact on a wide range of conditions.
NHS Five Year Forward View https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
Somerset Sustainability and Transformation Plan http://www.somerset.gov.uk/stp/
Public Health England/NHS England Commissioning for Prevention https://www.england.nhs.uk/wp-content/uploads/2013/11/call-to-action-com-prev.pdf