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Independents' Day

Study finds smokers less likely than others to attend NHS Health Checks

People who took up the Government’s national NHS Health Checks programme to check cardiovascular risk were much less likely to report smoking than those who didn’t participate in the scheme, according to latest research that appears to back up GP critics’ concerns that the scheme is widening health inequalities.

The study - reported in the Journal of Public Health - looked at the GP records of over 90,000 people who underwent risk assessment through the NHS Health Check programme between 2010 and 2013, compared with those of over 180,000 similar people with no record of ever having the NHS Health Check.

The proportion of current smokers in the NHS Health Check group was 5% lower than in the control group – 21% of men and 16% of women in the former group were smokers, compared with 26% and 21% of control group men and women.

The study’s authors said this suggested that ‘a higher proportion of non-smokers attended for health checks’.

The study found a higher rate of diagnosis of hypercholesterolaemia in both men and women, and hypertension in men, who underwent Health Checks, while the proportion of people on statins or antihypertensive therapy was also higher among the Health Checks group.

However, the authors cautioned that ‘the effectiveness and longer term outcomes of behaviour change approaches to risk reduction following a health check remain uncertain and require further research, leading to the development of more effective intervention strategies’.

The findings come after the RCGP called for the programme to be scrapped amid concerns from leading GP critics that it is diverting resources to the ‘worried well’ and exacerbating health inequalities.

Professor Azeem Majeed, from Imperial College London, whose independent evaluation has questioned the effectiveness of the NHS Health Checks programme, said the findings reflected these earlier concerns over health inequalities.

Professor Majeed said: ‘It is often the case with health checks that it is the healthier, more motivated people who attend.’

Public Health England relaunched the NHS Health Checks programme in 2013 with a commitment to reaching all fifteen million eligible people by 2018, and has defended its evidence base – although it is evaluating evidence on the scheme’s impact in order to refine the approach as it is rolled out.

J Pub Health 2015; available online 7 September

Readers' comments (5)

  • Vinci Ho

    Not surprised of the result.
    Health inequality?
    I would like to look at the bigger picture of income inequality instead:
    Income inequality data update and policies impacting on income distribution : United Kingdom(February 2015)

     In the UK, the average income of the richest 10% is almost 10 times as large as for the poorest 10%. The OECD average is 9.5, in France and Germany it is around 7 and in the US 16.
     Between 2005 and 2011 the average income of the poorest 10% in the United Kingdom fell 2% in real terms. While the average household income in the UK is slightly lower than in Germany and France, the average income of the bottom 10% in the UK is much lower.
     The share of the top 1% of income earners increased from 6.7 % in 1981 to 12.9% in 2011. At the same time, the top marginal income tax rate saw a marked decline: dropping from 60% in the 1980s to 45% today
     The level of income inequality among the total population in the United Kingdom has been well above the OECD average in the last three decades. From a peak in 2000 and subsequent fall, it rose again since 2005. Recent data up to fiscal year 2012/13 suggests inequality has been constant since 2010.
     Taxes and benefits reduce income inequality by a quarter in the UK. This is in line with the OECD average, but below other European countries such as France, Germany or the Nordics.
     Changes in taxes and benefits combined have reduced household income on average in the UK since 2007. The reduction has not been as large as in Ireland, Portugal, Iceland and Spain, but on the other hand, in United States, Germany, Estonia and France, tax-benefit changes increased household incomes over the same period. While in other countries income tax changes played an important role, in the UK fiscal consolidation was driven mainly by changes in benefits.
     Families earning around the average wage tended to gain, particularly due to the increase in the income tax basic allowance. The impact on families in unemployment and with low earnings was dependent on the family composition: Families without children tended to lose, mainly due to changes in housing benefits. Families with children tended to gain through the rise in the child tax credit. Policy changes also reduced the income of higher earnings families due to the withdrawal of child benefit and higher social contributions.

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  • of course
    nhs health checks are a pathetic non evidence based piece of nonsense wasting nhs resources that should have been aborted before its birth.
    a complete wasteful idiotic farce.

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  • If I was a smoker I would not have a health check as I know I would be in for a lecture.
    People are not stupid, they make their own decisions and the number of people who do not know that smoking is bad for you is tiny.

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  • Dear All,
    Why waste any more time and effort in researching this. We have 50 years worth of data that proves that those that turn up for health checks are the least needy of them, its "bleedin" obvious why. Population wide non focused general health checks do not work and are a waste of valubale resource.
    Paul C

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