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Better public health requires better laws

Are we really ‘shocking’? That’s how Jeremy Hunt branded Britain’s performance in the life-expectancy stakes a couple of weeks ago.1 The Global Burden of Disease, Injuries and Risk Factors Study compared the UK with several European countries, Canada and the US in a report published in The Lancet. It found that ‘the performance of the UK in terms of premature mortality was persistently and significantly below the mean’ of similar countries, prompting frenzied calls for action.2

The disease burden of substance misuse and mental illness was highlighted as a particular problem in the UK. But it’s important to note the study also showed some success – life expectancy in the UK at birth rose by 4.2 years between 1990 and 2010.

Nonetheless, Hunt responded: ‘I want the reformed health system to turn this shocking underperformance around.’

But who is really underperforming? Is it the health service – or is it the politicians who have a remit to shape public health strategy and make public health law?

We have lots of evidence about what does and doesn’t work when it comes to improving the health of the nation. Yet when the DH put out its press release on CVD strategy,3 timed to address the problems raised in the Lancet paper, its proposed solutions were: more defibrillators; genetic testing; joined-up, seven-days-a-week NHS CVD services; better detection of atrial fibrillation; and NHS health checks.

In other words, much of the Government medicine being offered to reduce CVD mortality and morbidity comes down to ‘more screening’. But we know screening comes with harms and isn’t useful in primary prevention; we know blood pressure targets exceed the evidence base,4 the numbers needed to treat are large and statins’ side-effects are many.

Despite this, as far as the Government is concerned, public health seems to focus on screening as a population intervention, when the poor evidence base might imply it should only be offered with meaningful individual consent.

Conversely, there is plentiful evidence to show that making new laws is often a good way of improving health. We have seen this with asbestos, smoking in public, child labour and clean water. Yet, as I write, the minimum pricing for alcohol legislation – which is supported by a great deal of evidence5 – appears to be in its death throes.

There is widespread acceptance that screening should be financed to the last penny, while people with severe depression have to wait 12 or 16 weeks for cognitive behavioural therapy. These warped priorities just don’t make sense – and they certainly aren’t supported by evidence.

It’s time we as a nation started to keep healthy people safe from the excesses of screening, to protect them with fair public health law and to concentrate our medical resources on evidence-based interventions for those who are sick and suffering.

Dr Margaret McCartney is a GP in Glasgow


1 Guardian. ‘Healthy life expectancy is shorter in the UK than abroad’.

2 Lancet. ‘UK health performance: findings of the Global Burden of Disease Study 2010’.

3 Department of Health. ‘Cardiovascular Disease Outcomes Strategy’.

4 Cochrane Library. ‘Pharmacotherapy for mild hypertension’.

5 University of Sheffield. ‘Model-based appraisal of alcohol minimum pricing and off-licensed trade discount bans in Scotland using the Sheffield alcohol policy model (v 2)’.

(All pages accessed 22 March 2012)