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Just because we’re not at the top of a league table it doesn’t mean it’s time to relegate us



Being lambasted for ‘shocking underperformance’ before you’ve even had breakfast is never a good way to start your day. With the publication of new analysis of the Global Burden of Disease 2010 (GBD2010) study last week, the news was peppered with gloom about the UK ‘faring badly’, ‘lagging behind’ and ‘failing to stop the rot’ as we were compared unfavourably with the rest of Europe.

The problem was that The Lancet had published an irresistible set of league tables, accompanied by a snazzy set of interactive visual representations of the data. With league tables come comparisons – which may be of value in determining which team should win the premier league, but are of questionable worth when comparing the health of nations.

Why does it matter if Germany is ranked one place above the UK in terms of life expectancy? Would my patients be any healthier if German citizens had fared worse? Listening to the news that day you could be forgiven for believing the UK were in some Health Super-League of Nations and were in danger of relegation.

We shouldn’t ignore GBD2012, though. It is such an important piece of research that its findings, and our response to them, must be considered very carefully. To read the headline figures and conclude that the health of our nation is in crisis would be far too superficial an analysis of over 2300 pages of research – and to lay all the blame squarely at the feet of the NHS, as the Health Secretary was falling over himself to do in his comments on the UK’s performance, is as ignorant of the causes of ill health as it is insulting to those who are committed to providing the best possible healthcare in this country.

To imply that the burden of disease in a country is only the responsibility of its health service would be like accusing the UK Government of sole responsibility for the global recession. Just as George Osborne would be quick to point out that the crisis in the Eurozone, and the lack of growth in our trading partners are factors beyond his control, so too there is a complex interplay of social determinants that will influence a nation’s health.

Health has its part to play of course, but the causes of the major players in disease – smoking, obesity, alcohol consumption, poverty and loneliness to name a few – extend far beyond the confines of any hospital or GP surgery. Healthcare will always do its best to pick up the pieces when the cracks in our society show up in the lives of patients, but cannot be held to blame for all the fault-lines.

The most worrying feature in the story was Jeremy Hunt’s declaration that he has a plan – more checks, more investigations and more medicine. Even the league tables themselves give a clear indication that more medicine may not be the answer – the US, the nation most addicted to medical intervention, has a lower life expectancy than the UK, and this gap has widened since 1990. The  Cochrane review published last year found ‘no benefit from routine health checks.’

To propose action on the basis of GBD2010, we must base it on the evidence of what will work, rather than on what is politically palatable. Big winners are likely to be in public health – with plain packaging of cigarettes, minimum alcohol pricing and tighter regulation or taxation of food linked to obesity being top of the list.

The Department of Health’s determination to use screening in an attempt to improve the cardiovascular health of the nation was published, by some strange coincidence, on the same day as The Lancet’s paper. And guess what? They are planning a league table!

The Health Secretary seems to be taking tips from his colleague in education, with his proposal that GPs will be compared in respect to their cardiovascular disease diagnosis rates, and that ‘support’ will be given to those deemed to be diagnosing too few.

I’m not bothered by the threat of league tables – I’m sure patients will always be more concerned about how easily they can get an appointment, and whether or not I will listen with care to their problems.

There is something ominous about the word ‘support’, however. If I am to have a bureaucrat metaphorically sitting in my consulting room, instructing me to sell statins to patients who don’t want or need them in order to hit a Government target I don’t believe in – then I really will have a problem.

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.