This site is intended for health professionals only

At the heart of general practice since 1960

Don't prevent action against preventable ill health

Dr Kailash Chand

Dr Kailash Chand


Medical science has made great strides in the 36 years I’ve been a GP, and, as a society, we are living longer lives. On the surface, this sounds like a success, but these extended lives aren’t always healthy, happy ones. A recent paper by the BMA draws attention to the need to prioritise healthcare prevention and tackle the leading causes of preventable long-term conditions.

Across the UK, there are an estimated 15 million adults living with long-term health conditions. Since 2003, the amount of hospital admissions from those with more than one long-term health condition has increased by over 200%. There are over 55,000 new cases of breast cancer in the UK – around 15% of all cases. The next most common cancers, prostate and lung, account for about a quarter of all cancer cases.

Aside from cancer, conditions caused by hypertension, such as coronary heart disease and strokes, affect millions and take many lives especially, when this high blood pressure is undiagnosed.

While liver disease in generally decreasing among our European neighbours, deaths from liver disease are increasing in this country. For instance, almost 21,600 deaths a year are caused by Type 2 diabetes.

By 2050, it’s predicted that two million people will be living with dementia due to our ageing population, and long-term health problems often come hand-in-hand with mental illness. Nearly a third of people with a chronic health complaint also suffer with mental health.

Our health is too precious to be ignored... Our children will thank us

It seems like a dreary forecast, especially when you look at this picture and see several missed opportunities to correct the health of our nation, like many doctors do when they’ve noticed the increasing demand for GP appointments. But the silver lining to this stormy cloud is that these conditions have preventability in common. They’re largely based on lifestyle changes, so stopping smoking, eating more healthily, and exercising more have a role in avoiding them. So, what are our leaders doing about this problem, that simply can’t be ignored any longer?

Politicians and policymakers openly recognise the relationship between lifestyle and poor health. In his first speech as health secretary, Matt Hancock said that everyone has a part to play in preventing ill health, ‘from the education we receive, to the home we live in to, to the job we do .. all of this shapes our physical and mental health.’

If the minister does believe this, he must agree that reversing the swathe of £550m’s worth of public health cuts to council budgets, yearly decreasing from now until 2021, would be a sensible place to start.

Because the other tragedy of preventable illness is that the most deprived are most at risk. Life expectancy varies by decades between prosperous districts and those where unemployment and poverty are rife. The health service has been slow to respond to these societal changes, now and in previous years, when within these changes lie the secret to the NHS’s long-term sustainability. Lifestyle principles across the board are much more powerful than anything a doctor can do for his patients. Significantly more than 90% of modern diseases are preventable through education. A heart attack can cost £20,000 to treat. If it can be prevented, there are huge cost implications. I would estimate that 50-70% of my patients’ medical costs wouldn’t just be reduced, but eliminated, if their diets were healthier and they exercised more.

You would hope that bureaucrats might see merit in the economic case for prevention, even if they can’t see that it’s unacceptable for so many people to be needlessly dying. Preventable ill health accounts for an estimated 50% of all GP appointments, and the demand on health services could be cut by as much as approximately 40% with the right investment in services to reducing smoking, alcohol consumption, physical inactivity and poor diet. All in all, this could save the NHS billions of pounds.

Where could our leaders start? Our health is too precious to be ignored when Parliament debates our laws, so Government needs consider health in all laws. This means increasing the tax on cigarettes, introducing a minimum unit price for alcohol and restricting the marketing and promotion of unhealthy food and drinks. Our children will thank us.

The NHS long term plan has ambitions to prevent 150,000 heart attacks, strokes and cases of dementia in England over the next ten years. But how, without adequate funding, workforce, training, resources and culture changes? This, too, would turn out to be another pipe dream!

Dr Kailash Chand OBE is a retired GP in Tameside

Rate this article  (3 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (4)

  • The article is true - a lot of illness is preventable. In my experience the public know this and often not willing to make changes

    In Nottingham - the CCG have dumped liver screening on us GPs essentially GPs are being asked to request 1000s of fibroscans and manage these patients. The CCG say it’s not - but it is widespread screening via general practice with no payment attached

    the worry is - screening which is not in our contract will be dumped on general practice and when it doesn’t work - we will once again be blamed

    Unsuitable or offensive? Report this comment

  • Cobblers

    I am confused Gp712. No payment to me equals no work.

    Why are you doing this?

    Unsuitable or offensive? Report this comment

  • @cobblers they have released it as local policy - some of us have complained

    If we don’t do it - the risk is of patients suing us and legal cases for not following a guideline

    Trust me - as a practice we don’t do work that is not funded - but we are stuck here and seeker advice from MPS

    The CCG did not factor in the workload on primary care. The worst thing is - if they are found to have liver damage - there is no treatment just lifestyle advice but we don’t have anywhere to refer them

    The money would have been better spent on stop smoking advisors which have been virtually wiped out!

    Unsuitable or offensive? Report this comment

  • I call BS on this Kailash. Trying to enforce/compel prevention via the state/funded by the taxpayer whilst providing universal healthcare and welfare doesn't work....

    You seem to conveniently ignore our annual deficit and increasing national debt. The problem is not the cuts, its far more fundamental than that. The solution is the exact OPPOSITE of what you propose, its giving responsibility back to the public, and making them responsible for their own health decisions.

    Unsuitable or offensive? Report this comment

Have your say