The Health Foundation, an independent charity, recently published its report into healthy life expectancy (HLE). HLE is the average number of years a UK citizen can expect to spend in good health. Over the past decade it has fallen by around two years to just under 61 years. Comparison across 21 high-income countries is sobering: most saw gains in HLE. The UK slumped to 20th place, with only the US faring worse.
The decline in UK HLE is indicative of a condition we might call myopic policy sclerosis (MPS). MPS has become endemic in NHS England and the Department of Health and Social Care. Symptoms include a delusional belief that the prevention of disease depends on professionals and pills, and an overwhelming phobia of public health experts.
A good lens to examine the ravages of MPS is myocardial infarction (MI or heart attack), a major cause of death and disability. Two important risk factors for MI are hypertension (high blood pressure) and tobacco smoking. We also have some good drugs: statins, which lower a third risk factor for heart disease, cholesterol, and anti-hypertensives for blood pressure.
The incidence of MI in the UK peaked in the mid-1980s and began declining thereafter. This wasn’t to do with pharmaceuticals: statins had only recently been invented and anti-hypertensives were not being widely prescribed. The most important factor was the drop off in smoking. In 1970, virtually half the adult population used tobacco; by the mid-1980s, thanks to a combination of taxation and health education, that had fallen to around a third. Smoking cessation halves the risk of heart disease, and does so surprisingly swiftly.
Average blood pressure started to decrease more rapidly in the early 2000s, when the government agreed a salt-reduction strategy with the food industry. Further tax hikes and the indoor smoking ban in 2007 saw tobacco use plummet further, heading towards its present-day level of around 13 per cent. Concomitantly, incidence of MI continued to decline. Then around 2010, that decrease abruptly stalled. And it did so in the face of a tsunami of pharmaceuticals. Since 2004, the government has been flogging the NHS ever harder to dish out drugs. There are 80 million prescriptions for statins annually, and for anti-hypertensives it’s four times that. Yet incidence of MI is once again on the rise.
Other factors have supplanted hypertension and smoking as causes, particularly metabolic ill-health as typified by obesity and type-2 diabetes. Prescriptions for anti-diabetic drugs have mirrored the explosion in statin use, and we’re now doing the same with GLP-1s like Ozempic and Mounjaro. Yet none of it is working.
The Health Foundation is clear in its conclusion: we will only improve the national health by relearning the lessons of tobacco and salt control. Health education, taxation and regulation of the food industry, and the ready provision of healthful options will do what an ocean of pharmaceuticals will not. And of fundamental importance is the restoration of socio-economic security nationwide.
For this to happen, the health-policy establishment must be purged of its pharmaceutically focused MPS. When he was shadow health secretary, Wes Streeting described his vision: how every government department would put health at the heart of its policymaking, addressing the socio-economic determinants of ill-health. He derided the Tories for looking to drugs to solve the metabolic ill-health crisis. But MPS is a contagious condition and Streeting has succumbed like his predecessors. There are antidotes: privilege the advice of public health experts and focus on population health strategies. And Streeting must be inoculated against those superspreaders of MPS, the siren lobbyists for the pharmaceutical industry. There is so much revenue to be had from industrialised medicine, Streeting’s MPS may be an intractable case. Yet the health of the nation depends upon him submitting without delay to the cure.
[Further reading: Young, down and out of work]
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