One in four Scots die unnecessarily
In Scotland alone, more than a quarter of all deaths each year are ‘avoidable’. As the name suggests, these include deaths where the underlying cause could have been prevented. The Office for National Statistics (ONS) defines these into two main categories:
- ‘Preventable’ mortality – when the cause of death could have been potentially avoided through public health interventions.
- ‘Amendable’ mortality – when the cause of death could have been potentially treatable through good quality healthcare.
Deaths may fall into one of the categories or both, depending on the situation. For example, road traffic accidents are classified as ‘preventable’, but not ‘amendable’ as it is possible to avoid most accidents. However, certain cancers are seen as ‘amendable’, but not ‘preventable’ as they often cannot be avoided, but early detection and treatment should mean survival. Conditions such as type 2 diabetes and lung disease can fall into both categories, as they can be prevented through a healthy diet and medically treated.
Such a high volume of preventable deaths puts an enormous strain on the NHS. However, since its inception, the very model of our National Health Service has focused on treatment over prevention. Emphasis is often placed on quick fixes, such as medication and surgery, rather than long-term preventive measures. This system has resulted in huge budget pressures to treat patients, rather than assist them to manage their own conditions and prevent serious illness.
Stages of preventive healthcare
Preventive healthcare encompasses clinical strategies to impede disease, rather than treat it, and spans across different levels of severity. ‘Primal’ prevention is the first stage, which includes any measures parents take to nurture their children in the early phases of their life. It also includes any actions taken to avoid potential health hazards in future and minimise factors known to increase the risk of disease, such as good sanitation.
‘Primary’ prevention involves measures to prevent the development of disease usually through lifestyle habits and diet. The risk of cardiovascular disease, for example, can be reduced through healthy eating, while the risk of lung disease can be minimised through not smoking. Primary prevention also includes improving resistance to disease through immunisation, such as childhood vaccines.
‘Secondary’ prevention includes measures to detect and treat disease prior to the appearance of any symptoms. This usually involves screening as a first step, such as smear tests to check for cervical cancer. The screening process relies heavily on patient engagement, as it is up to them to attend when they do not have any visible symptoms. Monitoring and treatment of hypertension, or high blood pressure, is another example of secondary prevention.
The next phase is ‘tertiary’ prevention and involves reducing the effects of disease during treatment and rehabilitation, as well as improving the patient’s quality of life once afflicted. The patient will be actively involved with the healthcare system at this stage, usually on a regular basis. Examples of tertiary prevention include surgical procedures to stop the spread of disease.
The final stage is ‘quaternary’ prevention and is concerned with protecting patients from so-called ‘over-medicalisation’, as well as ensuring treatment is ethical and non-invasive. In other words, protecting patients from treatment that does not work or where the risks outweigh the benefits, much like pharmacovigilance. Quaternary prevention is also crucial in combating disease mongering, whereby certain diseases are sensationalised for profit.
Barriers to preventive care
According to official UK Health Accounts from 2016, total healthcare expenditure in the UK was £191.7 billion. However, spending on preventive healthcare was just £10.3 billion – around 5% of the budget. In comparison, £46.4 billion (24% of the budget) was spent on long-term care, which includes management of long-term conditions such as cardiovascular disease and chronic obstructive pulmonary disease (COPD).
While the cost-effectiveness of investing in preventive healthcare and thus reducing the burden on long-term care may be obvious, there are several barriers to preventive care. While raising taxation on things like tobacco, alcohol and fizzy drinks may discourage consumption, it does not stop excessive consumption entirely. These are also reliable sources of revenue, which may be damaging to the economy to reduce significantly.
The benefits of prevention may also take a while to emerge, which can make it difficult to realise their potential. A long-term outlook is needed, especially for periods that span longer than annual budgets, to ensure enough resources are dedicated to the cause. Although, some preventive measures begin to show positive impacts faster than others, such as the public smoking ban first introduced in Scotland in 2006 and the rest of the UK in 2007.
Education is also an implicit barrier to preventive healthcare, particularly primary prevention. It may be difficult for people to understand what is and isn’t healthy food, for instance, and how to make sensible choices. Food labelling in the UK has progressed massively over the last few years in an attempt to help individuals make these choices, but it is still not unified across all manufacturers. Cost is another barrier here, as processed food tends to be cheaper than the likes of organic food, for example. Those with large families may find it particularly expensive to afford healthier food options.
Ignorance and misinformation are also barriers across multiple stages of preventive care. Parents may decide not to vaccinate their children, for instance, which increases their risk of affliction if they are exposed to a disease. Individuals may also choose not to attend voluntary health screenings, which could mean an underlying condition goes undetected.
Prevention is better than a cure
To address the financial strain on the NHS, a model that is focused on prevention over treatment is needed. With an aging population that are living longer than ever before, preventive healthcare is crucial for sustainability. While government campaigns like the ‘Five-a-Day’ initiative to promote healthy eating and the introduction of sugar tax to combat obesity are a step in the right direction, we need to look for new solutions that make preventive care accessible.
Wearable technology, such as Fitbit and Apple Watch, have empowered people to monitor and understand their own health in revolutionary ways. These should be leveraged as a means of preventive healthcare that allow users to be more informed and in control of their health. Our Lenus Digital Health and Care Platform is designed to do just that, enabling patients with long-term conditions to better manage their health and share this data with professionals to improve quality of care.
By facilitating self-management of conditions like COPD, hypertension and diabetes, amongst others, Lenus aims to support new preventive and continuous care models using remote patient monitoring and machine learning. This data combined with algorithms can help identify patients at high risk of hospital re-admission and support community discharge, easing the burden on the NHS and shifting the focus from treatment to prevention.