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Move beyond prevention and create health for a more prosperous society: Dr Axel Heitmueller

“We can improve our health. Why wouldn’t we want, as a nation, to maximise our health, not just accept what we have?” This is the idea behind the emerging health creation narrative championed by Dr Axel Heitmueller at the recent Dangoor Lecture at the Royal Society of Medicine.

Health creation, rather than health care, should be our focus for a healthier society in the UK, Dr Heitmueller told a live audience at the Royal Society of Medicine. In his talk, he sought to answer how we can fix the problem of the NHS currently acting more as a sickness service than a health service.

Dr Heitmueller, Managing Director of Imperial College Health Partners, began with a demonstration of the scale of the issue: 700,000 people have died prematurely in Britain over the last 10 years, across the full spectrum of ages - the equivalent of 10 or 11 jumbo jets falling out of the sky every month.

While some excess deaths can be explained by COVID-19, that isn’t the case for all. Dr Heitmueller suggested these excess deaths are caused by a combination of two factors. First, we have reached the frontier of medical knowledge. For example: after making huge progress for years, particularly in cardiovascular disease, we have now swapped heart attacks for heart failure, which is quite hard to postpone. Second, he cited Alzheimer’s, Parkinson’s, and other diseases not yet fully understood, causing many more people to die prematurely.

However, these global factors do not explain what’s behind all the excess deaths in this country – specifically the 250,000 that appear to be unique to Britain. Dr Heitmueller also pointed to the UK’s decline in global life expectancy rankings, as recently published in the Journal of the Royal Society of Medicine.

Emphasising the role of health inequalities, with data showing clear gender and socio-economic differentials in avoidable mortality rates in England, he said “We’re not in this together. If you have money and you live in the right place in this country, you’re not affected by this… your life expectancy is going up. There is a ginormous inequality hidden in these figures.”

Aside from the clear moral reasons for addressing these issues, there is a strong economic argument for improving the health of the nation. The argument that health is not just about wellbeing, it’s also about economic prosperity, is starting to carry some currency. Citing the 2.5 million people currently inactive (out of work) due to sickness, Dr Heitmueller said, “It becomes more and more clear, that if we continue to be such an unhealthy population, it has direct implications for GDP, productivity and other things.”

The question, then, is how the current state of health in the country should be addressed, and where the money should be spent. To answer this, Dr Heitmueller said we first have to examine the determinants of health. While this is difficult to quantify, according to analysis from Health Affairs, around half of this is impacted by personal choice and behaviours, 20% by the environment and 20% our genetic make-up, leaving just 10% due to the healthcare system. Despite this, the government grant for public health is £3.3 billon (2021-2022), versus £229 billion total spend on health (2021) – a huge disparity between where the drivers of health are and where the money is spent. “We have a burning platform, we have interventions that work, but we’re spending money in the wrong places.”

Paraphrasing Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO, Dr Heitmueller said, “We need to stop thinking about health as only the things that happen in hospitals and clinics. They happen on our streets, our workplaces, in our homes and so on. Health is everywhere. And unless we take that holistic approach, we are not going to shift the health of the nation.”

Finishing his talk, Dr Heitmueller emphasised the need to go beyond the current focus on prevention. “We shouldn’t stop at just prevention.”

Watch the 2023 Dangoor Lecture in full on our YouTube channel.

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