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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: http://www.bmj.com/content/353/bmj.i2793 

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.