Improving the population’s health and preventing illness and disease is key to reducing health inequalities and is at the heart of the NHS Long Term Plan. Secondary prevention – catching the causes of ill health as early as possible to prevent or reduce the chances of them leading to more serious conditions – has been a focus for NHS England since it was established in 2013. For example, it was an aim of the 2015 Five Year Forward View which successfully delivered the world’s first national NHS Diabetes Prevention Programme, resulting in a 7% reduction in the number of new diagnoses of type 2 diabetes in participating areas between 2016-2018.
Many conditions which can contribute to shorter healthy life expectancy are preventable. While the factors which can lead to these conditions are many and varied – in many cases beyond the control of health services – the NHS is taking action to help people improve their own health, from targeted support to help people reduce their dependency on alcohol or tobacco, to offering weight management services, to prescribing statins to prevent heart attacks.
The burden to the NHS of cardiovascular disease, a largely preventable disease, costs over £18 billion. Prevention is therefore not only important in reducing disease and improving health, but also in saving NHS resources, allowing money to be redirected to other essential areas of treatment and care.
The Global Burden of Disease study found the top six risk factors driving mortality and morbidity in England were tobacco, high blood sugar levels, high body mass index, dietary risk, high blood pressure and alcohol use. The NHS Prevention Programme’s focus is to support individuals in taking action to reducing these risks to their health. We know risk factors are often clustered within populations experiencing higher deprivation and so we’re utilising the ‘Core20PLUS5’ approach by developing and implementing targeted interventions at scale. In July 2021 we successfully rolled out the NHS Digital Weight Management Programme to provide targeted support for adults living with obesity who also have a diagnosis of diabetes, high blood pressure, or both. We’re helping people admitted to hospital, pregnant women, and people with severe mental illness to stop smoking. And we’ve established alcohol care teams in parts of England where alcohol related harm is highest.
As well as supporting people to play an active role in their health, our aim is to get to a point where we detect diseases earlier. To that end we are screening and treating infectious diseases such as TB through the Latent TB Infection Programme, along with the routine opt out testing of HIV, hepatitis B and hepatitis C in A&E departments in areas with the highest rates of prevalence. Finally, the programme is leading on the implementation of the Antimicrobial Resistance National (AMR) Action Plan to reduce the use of antibiotics and prevent infections across the NHS in England.
Tackling health inequalities is core priority for NHS England. People from more deprived backgrounds are more likely to have long term health conditions and suffer poor health. On average people in the most deprived fifth of the population develop multiple long term conditions 10 years earlier than those in the least deprived fifth.
The clustering of a small number of modifiable risk factors within certain communities is a key factor which drives premature mortality, overall poor health, and health inequalities. Tackling these are at the heart of the work being taken forward by NHS Prevention Programme.
The NHS Prevention Programme is specifically looking at the early detection of disease and also promoting, supporting and encouraging individuals to take action through supported self-management. The programme extends to the targeted screening and treatment of rare infectious diseases through the Latent TB Infection Programme and routine HIV testing in A&E departments in areas with the highest rates of prevalence. Individuals will also be simultaneously tested for hepatitis B and hepatitis C, not just HIV.