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20 November 2015

Who is responsible for our health?

Overweight? Unhealthy? Unfit? It’s time people took more control of their health – but are they ready to do so? 

By Becky Slack

Whose responsibility is our health? Government? Employers? The food and drink industry? Ourselves? Whereas one person might be comfortable to hand over control of his well-being to others, the next person may not.

Whatever New Statesman readers may think, there is one fact that cannot be ignored: too many of us are eating too much, drinking too much, smoking and not doing enough physical activity – and that is beginning to take its toll on our health and our health-care system.

There are an estimated 3.2 million people with diabetes in the UK, already one million more than ten years ago, and the figure is predicted to reach four million by 2025. There are now more than 3,000 alcohol-related admissions to A&E every day. One in five adults still smokes. Almost two-thirds of adults are overweight or obese, and, shockingly, so, too, are a growing number of children. Fewer than one in ten children are obese when they enter reception class, but by the time they’re in year six, that figure is nearly one in five.

The NHS is bearing the brunt of this. As it states in the Five Year Forward Review:  “As the ‘stock’ of population health risk gets worse, the ‘flow’ of costly NHS treatments increases as a consequence . . . Put bluntly, as the nation’s waistline keeps piling on the pounds, we’re piling on billions of pounds in future taxes just to pay for preventable illnesses.”

Quite rightly, the NHS strategy places considerable focus on prevention. It makes more sense to roll out a national programme of intensive lifestyle intervention programmes than it does to spend more money on dealing with the health complications stemming from an unhealthy lifestyle. A key ambition of the NHS, therefore, is to “become the first country to implement at scale a national evidence-based diabetes prevention programme modelled on proven UK and international models, and linked where appropriate to the new Health Check. NHS England and Public Health England will establish a preventative services programme that will then expand evidence-based action to other conditions”.

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But does the public understand its own role in this prevention strategy? Research shows there are contradictions at play that need to be addressed if significant results are to be achieved. For example, a recent report published by Philips, Picture of Health, shows that UK adults and health-care professionals both agree that preventing poor health is the responsibility of the person in question. However, only 38 per cent of professionals believe patients understand that prevention is better than cure, despite patients reporting the opposite. Indeed, at present, less than half of UK adults are actively managing their health. All of this shows there is a clear disconnect between what they think they should do and what they actually do, and that it is time for people to engage actively with their health.

“If you look at the different age groups, millennials are very actively monitoring their own health but they’re a bit confused as to what they can do with the data [that their apps and health trackers provide]. Conversely, the 55-to-65-year-old cohort are very confident that they’re managing their health in a big way but when you actually ask them what they’re doing, they say that they weigh themselves, brush their teeth and visit their doctor occasionally, which is not particularly active engagement when it comes to managing your health,” said Sean Hughes, vice-president of design at Philips, speaking at a recent event hosted by the RSA called “Our Health: Who Cares?”.

Overall, less than half (45 per cent) of British adults say they are actively managing their health. Of those who aren’t, a quarter (26 per cent) know they should be more active but don’t have a strong desire to be so, and 8 per cent admit they just don’t do it.

Of course, all sections of our society have a responsibility for our health in one way or another, be it food manufacturers reducing salt and sugar in our food, local authorities seeking to limit junk-food outlets near schools, or employers ensuring positive well-being in the workplace – and this was reflected in the Philips research. About half (48 per cent) of respondents felt that corporations, such as the food and drink industry, should bear responsibility for our health, closely followed by the NHS (46 per cent) and educators (39 per cent). One in three (32 per cent) believe the onus lies on the media, while (22 per cent) think it is their employers’ responsibility.

Again, age influenced opinion. Millennials were much more likely to see other actors playing an active role in public health, half (50 per cent) of them believing that legislation could be a positive move. This was in contrast to most adults, of whom only a third (37 per cent) felt that the government should legislate. Meanwhile, many more health-care professionals were in favour of legislation – some 64 per cent of primary and 55 per cent of secondary health-care professionals would support new laws.

In general, British adults have a reactive outlook on making meaningful lifestyle changes. Most (71 per cent) waited until they had physical symptoms or were given a warning by their doctor (69 per cent). Very few are motivated by others; only 22 per cent said seeing a friend or family member experience a health problem would prompt them to change their behaviour and just 11 per cent would be inspired to change after seeing a friend or family member take charge of their own health.

“There is an interesting aspect in the report in terms of who’s responsible for prompting people to actually think [about their health]. We probably all believe that it’s everybody – individual, community, industry, third sector, local and national government – but it really has to be a whole system change,” said Tim Chadborn, behavioural insights lead researcher at Public Health England, who also spoke at the RSA event. He gave examples from within the NHS of initiatives such as the NHS Health Check programme, which invites people to talk to a trained health-care worker about their diet and physical activity, and Making Every Contact Count, which encourages health-care workers to stress the importance of prevention when they see members of the public. “For instance, we know that if someone is a smoker and goes to see a doctor and the doctor doesn’t ask about their smoking, they’re actually less likely to quit,” he said.

Knowledge is power

Individuals can be greatly helped by knowing what options they have, what these cost the taxpayer in terms of time and money, and how they may affect their ability to work and play. Better education clearly should play a part in the strategy.

Brits have already indicated they are hungry for information: three-quarters have gathered information about health and wellness from more than one source in the past year (primarily health-related websites). Seventy-one per cent of those who use connected devices and apps to track their health believe technology has empowered them to take control of their well-being. In addition, younger adults feel that their ability to manage their health would be boosted by support from professionals, such as a health, nutrition or fitness expert (36 per cent); by consistent information and advice from experts (33 per cent); by guidance on how to put information into practice (30 per cent); and by personalised consultations and treatments from their doctor (28 per cent).

Providing people with the tools they need to take control is vital, says Tim Kelsey, NHS national director for patients and information, who believes access to data is at the heart of this.

“From this April we’ve become the first country in the world to offer all our citizens access to GP records, online bookings, repeat prescriptions . . . The public is ready and willing: we just need to get ready to give them more control when they want it,” he said at the RSA event.

Philips’s Hughes concurs: “We believe we can break free from the inertia of inaction by connecting people and professionals with accurate and personalised health data. This, combined with solutions that keep healthy people well longer and aiding people to manage health at home, is the key to a hearty and better future for us all.”

A similar sentiment comes from within the NHS itself. Some 62 per cent of primary and 69 per cent of secondary health-care professionals believe that access to health data is a patient’s right and that individuals should have access to more of it. Indeed, 55 per cent felt that being given such access would increase patients’ sense of responsibility for their health.

A problem shared is a problem halved

It seems obvious that the job of clinicians and the health-care system is to take care of people when they are sick, but when the impact of every individual patient case is considered as a whole – and we see the implications this has for budgets, staffing, volume of services and so on – it becomes clear that responsibility for our nation’s health has to be shared, so that the NHS is not required to shoulder the whole burden alone.

Creating the type of environment that empowers and supports people to make informed, balanced choices will help them lead healthier lives, and will go a long way towards maintaining the health of the NHS itself.

This article is part of a thought-provoking series on living health, brought to you by New Statesman in association with Philips, that looks at how technology, innovation and big data are helping to improve your health and our health-care system.

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