30/10/2015 11:05 GMT | Updated 29/10/2016 06:12 BST

Prevention, Prevention, Prevention: What a Ground Breaking Study Means for Health in England

In September, influential medical journal The Lancet published a study which helps us take a fresh look at the way people in England are affected by ill health.

We can now compare how different diseases (like cancer or heart disease) and risk factors (such as smoking or alcohol) have caused death and disability across England since 1990.

This is the first time a study like this has been done in England and it helps health professionals like me test whether the effort being expended on a particular disease or risk factor in a particular area is proportionate. Indeed, anyone can do this by playing with the interactive tool produced alongside the study.

This study could help show the way for public health in England.


Things have generally changed for the better: we are living longer. But the picture is complicated. Yes we're living longer but we're spending more years in ill-health, often living with a combination of conditions, some of which would have previously killed us.

Take diabetes for example. Less people may be dying as a result of it, but many more are living with it and suffering a lower quality of life because of complications like sight loss, kidney problems and stroke.

Also, the increasing proportion of ill health lost to longer-term, chronic diseases like lower back pain and dementia, points the way for future priorities.

This is what public health professionals call "multi-morbidity", and this growing form of illness will require changes to the way our health and social services work so that they meet the needs and circumstances of individual patients.

The study also shows us that 40% of ill health in England is due to potentially preventable risk factors, with unhealthy diet and tobacco being the two biggest risks. In other words, if we improve in these areas, the implications and opportunities are potentially huge.


I was also fascinated by regional differences highlighted in the study:

  • Some English regions (South West England, East of England, and South East England) now have similar or better levels of health than the best-performing countries in the world like Italy and Sweden.
  • Other regions (North East England and North West England) perform more poorly when compared to these high-income countries.

This demonstrates the potential we have in England. If the worst region matched the best, we would be one of the healthiest countries in the world.

These differences, between the South East and North West for example, are down to levels of deprivation, not geography, and certainly not the quality of healthcare, which is broadly the same across England.

The real solutions lie at the front end, in prevention (stopping people from getting ill in the first place) and tackling the deprivation.

It is worrying that these obvious differences exist and all the evidence suggests that the root cause of these health inequalities lie outside the health service. So while it is wrong to blame the NHS, it certainly doesn't mean there's nothing we can do about it. We can, and this why we get up in the morning.

One part of the explanation is that the behaviours that cause disease (such as smoking and lack of physical activity) are more common among the most deprived.

For instance, we've seen big falls in smoking rates but they've fallen further in wealthier areas than in the most deprived areas.

The bigger question is why people adopt these behaviours in the first place and here we have to look at the start we get in life, our homes and jobs as well as the different opportunities available to us to improve our health according to where we live.

It's now acknowledged more than ever that we have to get to the root cause of these risks. Across the country public health experts are working with your local councils and the NHS, whether to provide guidance on healthy levels of sugar and running child measurement programmes through to launching campaigns like Change4Life and Stoptober.

We're looking at the potential of e-cigarettes to reduce smoking; programmes to help people take control of their health like the NHS Health Check and Diabetes Prevention Programme amongst a host of other work.

Because this all takes time - we need to do things now that may only bring benefits in the years ahead but also help people take control of their own health today. Individuals have the power to change their lives for the better now, whatever their age. We're all living longer, so it's up to us to make sure we make those years' healthy ones.

The richness of this new picture of England may be surprising to some, but the exciting potential is clear to me. It is only by working across the whole health sector, local and national government, as well as voluntary groups and charities, that we will see everyone in England living the longest and healthiest lives.