“An ounce of prevention is worth a pound of cure,” Benjamin Franklin’s adage goes. Yet that simple prescription has been hard to follow in the current NHS. As has been frequently highlighted, one of the biggest challenges for the health system is not just how much we spend per capita, but where and when it is spent. In England, there has been an ongoing shift within the NHS budget towards acute hospital care – treating people in hospitals, often after they are already quite ill – while funding for primary care such as GPs has fallen.
The consequence is that the NHS is increasingly paying for serious and expensive disease treatment, rather than investing upstream to prevent disease in the first place. We spend heavily on dealing with heart attacks, strokes and other life-threatening conditions, rather than identifying those who are at higher risk and intervening earlier to reduce their chances of getting ill.
So, it’s excellent news that the NHS in England will begin to offer free cholesterol tests, and the offer of a blood pressure check, in participating high street pharmacies for those aged 40 to 84. The nationwide phased rollout follows a pilot study in north London in which close to 2,500 patients were checked across 61 community pharmacies. Nineteen percent were found to be at high risk of a heart attack or stroke and were offered advice or referred for medical treatment.
I think it’s a brilliant policy move: it is convenient, relatively inexpensive, takes pressure off GPs and hospitalsand, most importantly, can reduce preventable suffering and deaths. From decades of population-level studies, we have solid data on the factors that can help us predict the risk of serious conditions such as heart disease, type 2 diabetes and some cancers.
There are a staggering number of health tests available (and many that are advertised to us by private companies touting “health checkups”). But I’d say (combining my public health and personal trainer backgrounds) that a small number of low-cost, simple measurements and tests are enough to provide a really useful snapshot of health status and indicate whether intervention is required, either through lifestyle change or medical support. It wouldn’t take much to offer an annual health MOT in community pharmacies.
I’d start with blood pressure: a simple test reveals how much pressure circulating blood is putting on the walls of the arteries and the cardiovascular system. Hypertension (high blood pressure) is often called the silent killer because you can feel perfectly fine while internal damage is accumulating.
Next I’d say a simple waist circumference measurement. This isn’t anything to do with how you look, but rather that where we store fat matters for our health, perhaps more than how much we weigh. Visceral fat, fat around our organs in the abdomen, is associated with high blood pressure, insulin resistance (linked to type 2 diabetes) and heart disease. For good health, waist measurements should stay under 50% of height.
A brisk one-mile walk on a treadmill is a simple fitness test. Photograph: Boston Globe/Getty Images
Also a cholesterol finger-prick test, like that one now being offered. Knowing the cholesterol makeup in our blood can indicate longer term cardiovascular risk and whether dietary change or further medication, such as statins, are necessary to lower LDL (the bad) cholesterol. And while we’re pricking our fingers for blood, we could add a glucose/HbA1c finger-prick test. HbA1c measures average blood glucose over the previous two to three months and can identify those with increased risk of diabetes. Similar to hypertension, pre-diabetes and even early type 2 diabetes can be symptom-free, so tests are really useful to detect them early.
Finally, I’d like to see a simple fitness test. There are many ways to measure fitness, and no quick test is perfect, but you can learn a lot from just a one-mile brisk walk on a treadmill, and checking how many press-up can be completed in a minute. The walk shows cardiovascular fitness – how effectively our lungs, heart, blood vessels and muscles work together to deliver oxygen during exercise. The press-ups check strength and muscular capacity, both of which can give a sense of overall risk of disease, as well as life expectancy.
Knowing these results, plus whether someone smokes, how much they drink, their age and relevant family history, would give a rough, but pretty good, snapshot of health status in an inexpensive and accessible way. There would be some costs to roll out such tests in pharmacies, but it would surely save money for the entire system in the longer term by preventing illness and thus expensive treatments.
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Aside from the economics, you could be walking around symptom-free and not know you’re pre-diabetic, living with hypertension or at a high risk of a heart attack. You may only find out once you’re admitted to hospital or when a disease has progressed far enough to cause symptoms and pain.
That is precisely what prevention is all about. We already have annual car MOTs by trained professionals to prevent a dangerous breakdown on the highway. Doesn’t it make sense to do the same for our bodies?
