Contradictory priorities

Lauren Bishop on public health.

I recently read about the results of a survey on public attitudes about the NHS. There were two main results that were most striking for me: first, out of a list of eight options, people rated public health interventions – those that maintain wellness and prevent ill health – lowest, in terms of priority for NHS spending. To me this suggests that the general public is not well educated on the benefits of preventive measures: by prioritising treatment over prevention, we are missing the point that the need for treatment is reduced by effective prevention.

In an interesting twist though, here is the other result that grabbed my attention: when asked whether particular types of treatment should be rationed by the NHS, people were least likely to agree that bariatric surgery and liver transplants for alcoholics should be given freely for all (conversely, people were most likely to agree that drugs should always be given to extend life by less than six months in terminal illnesses). In other words, it seems that there is something of a tendency to believe that conditions most obviously associated with lifestyle factors are less deserving of free treatment. It also implies an attitude that people are, at least in part, responsible for their own health, and perhaps should not be offered treatment so freely for conditions that are seen to be more avoidable.

So, how does one minimise their chances of needing such treatment? By having a healthy lifestyle. And how do we improve people’s chances of having a healthy lifestyle? Preventative measures that help maintain wellbeing and promote good health! It seems there is a bit of a mismatch between these two key results of the survey, and one that should perhaps be addressed by educating more widely on the benefits of such interventions.

Such a lot of money is being spent on transforming the NHS right now to respond to the increasing demands of poor health on a population level. Aside from the obvious ones, more illnesses than we realise have their roots, to some extent, in lifestyle choices and social connection (or lack of). It is frustrating to know that so much could be achieved by investing more in social and public health measures, yet the immediate pressures placed on our health services make is almost impossible to invest proportionately in these. Even if we did, it seems the fallout would be massive: how dare we spend so much on the thing ranked bottom of the public list in terms of health spending priorities?!

How do we address this issue? I certainly don’t claim to know the answers, but I think those doing good work need to keep chipping away at it and perhaps the scales will eventually tip. I’m particularly impressed the examples given in May’s special issue of The Psychologist on the ‘social cure’ approach to health and wellbeing.

I hope to see more and more of this type of work in the coming months and years. If we continue to tackle the deepest roots of poor health and wellbeing, little by little, perhaps we can ultimately ease the burden on the NHS and on people’s lives. It’s a conundrum that won’t be easy to solve, but I plan to do my best to do my bit.

Lauren Bishop

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