Crunch time is approaching for the NHS as details are pinned down for the long-term plan to set the future direction of the health service. Fresh thinking is required to ensure health services are working to improve the population’s health, not just reducing the burden of disease.
One area where the long-term plan should encourage a new approach is in addressing the four risk factors that have the most significant impact on people’s health – poor diet, physical inactivity, excessive alcohol consumption and smoking. Our research shows that seven in ten people exhibit two or more of these risk factors, and that they often cluster and are more difficult to address in people from disadvantaged backgrounds. Studies have also demonstrated the link between multiple risk factors and increased risk of mortality.
Multiple risk factors should be treated as the precursor to the multi-morbidity challenges facing health services. Currently, however, a lack of joined-up thinking from services means that they are more often than not addressed in isolation.
It is therefore positive to see that one of the workstreams established to develop the long-term plan is focusing on ‘prevention, personal responsibility and health inequalities’. This suggests a recognition of the shared responsibility that individuals and health services have for keeping everyone healthy, and the importance of seeing people in the wider context of their lives.
There is good evidence of links between the four main risk factors and the clinical priorities identified for the long term plan (cancer, CVD and respiratory, and mental health). The factors are the greatest overall contributors to the number of years spent in bad health in the UK so a long-term plan that is focused on prevention and improving clinical outcomes must give priority to addressing them.
A recent report from the Guy’s & St Thomas’ Charity showed that huge numbers of people living with multiple long-term conditions also have one or more risk factors, highlighting the importance of primary prevention even for those who already have co-morbidities.
While the long-term plan is badged as a plan for the NHS, addressing multiple risk factors will require leveraging expertise and knowledge from the NHS’ partners, especially local government. In a recent report, we explored how some local authorities are rising to this challenge by designing services to support people in the round, addressing all of their risk factors at the same time. This includes bringing together services aimed at addressing these factors individually into a single service, providing one point of access.
Although local services are developing thinking in this way, policy development still tends to be siloed. Governments continue to publish separate smoking, alcohol and obesity strategies, when they need to take a lead in bringing thinking together across these risk factors and send a message to the system that they need to be addressed together.
Multiple risks should be taken as seriously as multi-morbidity. With so much focus being given to integrating health services in order to more effectively treat people with complex needs, why can’t we better integrate the health system’s offer for people with multiple risk factors?
The long-term plan provides the NHS and its partners the opportunity to grasp some of these policy nettles. The problem of multiple unhealthy risk factors, and its contribution to growing co-morbidity and health inequalities, can only be solved if the NHS long-term plan becomes a long-term plan for the population’s health.