NHS Health Check: an innovative component of local adult health improvement and well-being programmes in England.

Abstract

England faces an epidemic of largely preventable noncommunicable diseases, such as heart disease, cancer, type 2 diabetes and liver disease. Premature mortality in the UK is falling, but not as fast as in many other European countries. Around two-thirds of deaths among people under the age of 75 in England are estimated to be avoidable, through public health interventions or through early diagnosis and effective treatment. In 2010, cancer accounted for 40% of deaths for people under 75 years and circulatory disease, including stroke, accounted for 24%. The burden of non-communicable disease and disability falls heaviest on the most deprived communities. More than twice as many people in the most deprived quintile die of circulatory disease compared with those from the least deprived. There is a gap in life expectancy between the least and most deprived of 7 years for women and 9 years for men, and a far bigger gap in healthy life expectancy of 20 and 19 years, respectively. England has provided universal health care for over six decades. There is near universal general practitioner (GP) registration, and the country has implemented significant and effective public health programmes in recent years—including the reduction of salt in the manufacturing of food, cancer and non-cancer screening and smoke-free legislation. Yet, there are still high numbers of undiagnosed cases of preventable disease with an estimated minimum of 5 million undiagnosed cases of hypertension, 750 000 undiagnosed cases of chronic kidney disease (Stages 3–5) and 500 000 undiagnosed cases of type 2 diabetes in England. A retrospective audit of premature deaths from cardiovascular disease (CVD) in Leeds found that 30% of people who died of CVD were people who had not been diagnosed prior to their deaths and were therefore not on a disease register. These people lived on average 8 years less than people who were on a disease register. The recently published NHS Five Year Forward View and Public Health England (PHE) priorities argue for a ‘radical upgrade’ in prevention if improvements in healthy life expectancy are not to stall and health inequalities worsen. There is an urgent need to change course, on both prevention and early diagnosis. The rational approach is to take action now, where the evidence suggests that we can be effective. In this paper, we argue that NHS Health Check is part of this long overdue approach to engage and activate the public about their health, focus on prevention and risk reduction, and strengthen place-based leadership for health improvement. Rather than calling to abandon the programme for lack of scientific certainty, our efforts should be focussed on ensuring that NHS Health Check capitalizes on near complete population registration to promote population-wide health gain; that it is fully integrated with other local health improvement programmes, and that it is getting the best value and health impact for the investment through improved programme management, better implementation, robust evaluation and appropriate targeting—all of which are underway.