The health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health, the Chief Executive of NHS England tells the annual conference of Public Health England in Coventry today.

Simon Stevens points to the fact that nearly one-in-five secondary school aged children are obese, as are a quarter of adults – up from just 15 per cent twenty years ago. Unchecked, the result will inevitably be a huge rise in avoidable illness and disability, including many cases of type 2 diabetes which Diabetes UK estimate already costs the NHS around £9 billion a year.

“Obesity is the new smoking, and it represents a slow-motion car crash in terms of avoidable illness and rising health care costs,” Stevens says. “If as a nation we keep piling on the pounds around the waistline, we’ll be piling on the pounds in terms of future taxes needed just to keep the NHS afloat.”

In an NHS ‘Five Year Forward View‘ to be published next month, the NHS will set out some of the actions that could make a difference over the course of the next Parliament. Proposals being debated include:

• A shift in NHS investment towards targeted and proven prevention programmes. Stevens will point out that the NHS is now spending more on bariatric surgery for obesity than on the national rollout of the intensive lifestyle intervention programmes that were first shown to cut obesity and prevent diabetes over a decade ago.
• New incentives to ensure the NHS as an employer sets a national example in the support it offers its own 1.3 million staff to stay healthy, and serve as “health ambassadors” in their local communities. While three quarters of NHS trusts say they offer staff help to quit smoking, only about a third offer them support in keeping to a healthy weight. Three quarters of hospitals do not offer healthy food to staff working night shifts.
• Recommending that financial incentives should be offered to employers in England who provide effective NICE-certified workplace health programmes for employees. Stevens will argue that one of the benefits of a tax-funded NHS is that UK employers are not on the hook for health care costs, but that should not mean that the workplace is neglected as a setting for more concerted health action. Sickness absence-related costs to employers and taxpayers have been estimated at £22 billion a year, and over 300,000 people each year fall out of work and onto health-related benefits.
• A “devo-max” approach to empowering local councils and elected mayors in England to make local decisions on fast food, alcohol, tobacco and other public health-related policy and regulatory decisions, going further and faster than national statutory frameworks where there is local democratic support for doing so. Stevens will draw attention to the public health leadership of Michael Bloomberg as Mayor of New York City, and of leading local authorities in England.