This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

Diet and stop smoking schemes ‘three times more effective than Health Checks’

Government policies to promote healthier eating and curb smoking could cut three times as many heart attacks and strokes as the NHS Health Check scheme, researchers have estimated.

In a paper published in the BMJ, the team said introducing more policies like the ’sugar tax’ and tougher regulation of the food and tobacco industry would also help to reduce health inequalities further.

Researchers led by Dr Chris Kypridemos a PhD student in public health modelling at the Department of Public Health and Policy, University of Liverpool, used computer modelling to simulate the impact of population-wide ‘structural’ approaches as well as screening programmes like the NHS Health Checks scheme, using available evidence for each type of scheme.

They found that the population-wide approaches – introducing a tax on sugary drinks, making industry reformulate processed foods, for example to cut salt levels, providing subsidies for fruits and vegetables and placing stricter controls on tobacco – would prevent or postpone 67,000 cases of cardiovascular disease and 8,000 deaths by 2030.

By comparison, they found NHS Health Check screening approach would likely cut 19,000 cases and 3,000 deaths – and would also be less equitable than the population strategies, with people in lower socioeconomic groups gaining even less benefit.

The team found that the most beneficial approach would be to combine the population approaches with a targeted approach to screening, with health checks only done in the most deprived areas of the country with the highest rates of cardiovascular disease.

This combined approach would save 82,000 cases and 9,000 deaths by 2030, and would also be ‘the most equitable strategy’, the team reported.

Dr Kypridemos and colleagues concluded: ‘In England, despite the observed higher concentration of cardiovascular disease risk in more deprived areas, structural population-wide interventions targeting unhealthy diet and tobacco might be three times more effective than the existing screening policy.

‘Structural population-wide interventions are also likely to be more equitable than screening.’

It comes after the major new NHS programme on diabetes prevention was criticised by experts for being too narrowly focused on a clinical screening approach, with not enough emphasis on population approaches to tackle poor diet and unhealthy lifestyles.

The Government has also been criticised for dragging its heels with publication of a long-awaited obesity strategy, although ministers recently bowed to pressure to introduce a 'sugar tax' on drinks.

Professor Clare Gerada, former RGCP chair and BMA council member, who has previously called for the NHS Health Check scheme to be scrapped, told Pulse ‘the findings make sense, there is no point screening the whole world’.

Professor Gerada said: ‘We need to address the source of this and that is unhealthy lifestyles, which no amount of screening at the wider population level is going to get at – because we know those that most need to get screened don’t pitch up for their screening tests.

She added: ‘There was never any evidence for [NHS Health Check programme] - in fact there was evidence of the opposite, that it could do more harm than good. But we have entered the politics of health – unless the science says what the politicians want it to say, they ignore it.’

Jamie Waterall, national lead for the NHS Health Check programme at Public Health England, said: ‘PHE’s Expert Scientific and Clinical Advisory Panel (ESCAP) keeps all evidence for the NHS Health Check programme under review and will look at the findings of this study.'

BMJ 2016; available online 8 June: 

Health Check programme controversy

The NHS Health Check scheme was rolled out in 2009 and involves GPs screening everyone in the 40-74 years age bracket for potential cardiovascular risk factors, with follow-up and treatment recommended for anyone deemed to be at high risk of having a heart attack or stroke.

However, GP experts have questioned the evidence base for the blanket screening approach and warned it risks wasting resources and diverting GP time to healthy affluent patients, worsening health inequalities.

The RCGP has called for the programme to be halted altogether because of concerns around the evidence. Public Health England was recently forced to announce a review of the approach after a damning independent report found the programme was likely to avoid just one cardiovascular event each year for every 4,500 people screened.

Readers' comments (4)

  • Vinci Ho

    (1) Carpet screening needs support of solid criteria e.g. Wilson's , which is lacking in this screening and we also remember the arguments on carpet screening for dementia earlier on. Even so , so often it is narrowed down to a more meaningful age group like in bowel cancer and aortic aneurysm . Age from 40-74 is too much a wide range where true positives(as well as false negatives) are well diluted in terms of pick up rate . Targeting more deprived areas using extra resources freed up from discontinuing the screening in more affluent areas is debatable .
    (2) No health movement can work if the government folds up its arms making no effort to promote consistent messages for health professionals. One argues the government had not done enough to promote flu vaccination , irresponsibly leaving GPs and pharmacists to fight for attendants and as a result , the overall vaccination rate went down. DoH will do itself more justice in actually promoting health messages than constant spinning to serve for political agenda(s) set by the government .
    (3) Laying down legislation with penalty(higher tax , for example)to curb undesirable health behaviour is always contentious as it a negative reinforcement in conditiong.While enjoyment of the behaviour in question is a 'welfare' to the person and hence some respect of freedom is justified , educaton and promotion to honour the virtue of looking at the big picture of the health/welfare of the whole society must be the telos of the government .

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    .....negative reinforement in operant conditioning.

    Unsuitable or offensive? Report this comment

  • whats 3 times 0? lol

    Unsuitable or offensive? Report this comment

  • This remains about statins, or should be, and how we get them to those who may benefit.
    Long term use of statins can more than halve you risk of CVD
    All we need to do is identify those at risk and get them to take a pill a day ... Easy?
    Apparently not.
    The way forwards is probably to screen for coronary calcium.
    It identifies risk better and patients take their pills better when they know they have calcified arteries.
    Could do a study but will take 10years
    Or do nothing and wait for patients to have their stroke or MI and then treat. If they are still alive.

    Unsuitable or offensive? Report this comment

Have your say