Duncan Selbie, Chief Executive Officer of Public Health England gave a talk at the College’s Annual Meeting, exploring how we can make radical change to the health of the country.

He argued that while we pay lip service to prevention, but invest in illness, the national level of wellness is not going to shift, and we will remain trapped in a pattern of longer lives blighted by chronic conditions.

 He said that the sustainability of the NHS is imperiled by the burden of managing conditions such as obesity, smoking, alcohol and lack of exercise. Reducing these preventable illnesses will significantly improve the nation’s collective health and keep the NHS affordable.  Public health interventions are the best way to achieve this.

We have already seen the success of some public health interventions including the meningitis vaccine, seatbelts and the smoking ban in public.  The point of any intervention is the evidence to prove that it helps.

But calls to choose a better lifestyle have no traction on people too poor to change their lives.

Prosperity is the major factor in lifestyle choices.  Wealth really does equal good health and the statistics show that morbidity increases the further north you travel. Lack of prosperity is the challenge.  It’s down to the social determinants of health.

There are five central causes of poor health:

• Diet – one in five 5 year olds are overweight: by age 11, it becomes one in three.
• Alcohol – 80% of all the harm is from 20% of the drinkers
• Tobacco
• High blood pressure
• Inactivity

Duncan asked how we can help the workless into work, and provide good support to people who can’t work? Regardless of their work status, people need a reason to get up in the morning.

Welfare reform is at the cornerstone of improving health. There is enough money – it is how we choose to spend it.

Tackling child obesity isn’t just about educating individual children and their families.  It’s about looking at the whole social picture, including transport systems, the easy availability of bad food, and the ubiquitous marketing of food with few vitamins and minerals.

There is a huge amount to be proud of about the NHS, but we are obsessed with hospitals, which are only part of the picture.  The road to transforming public health begins with the narrative that we give about the NHS and the language that we use. Welfare reform is at the cornerstone of improving health. There is enough money – it is how we choose to spend it. Ultimately there should be no distinction between the NHS and social care, it’s all about people.

When you look back over time, people don’t listen to what you say or what you write, but they do look for what you do.  The truth for all of us involved in health is that we have talked about the importance of prevention but have carried on spending our money on treatments. This is not the way forward.  Prevention needs to be taken seriously and made a priority.