The NHS is in crisis. Waiting lists are at an all-time high and we don’t have enough money or staff to deliver care.
So how much do we need to spend on healthcare, and how many staff do we need to deliver that care? That depends on demand. The myth is that increased demand for healthcare is driven by an ageing population, but that isn’t the whole picture.
The reality is that the NHS, created in the middle of the 20th century, is ill-suited to health issues in the 21st century. When the NHS was founded, it was anticipated that health spending would decrease after a few years, as health conditions would be treated promptly in the early years and demand would fall. That didn’t happen.
“The health of the nation is poor: 63% of adults are overweight or obese”
In the UK, the average woman lives to the age of 83 years and the average man to 79 years. Although people are living longer, those extra years are marred by ill health. Disability-free life expectancy describes the “years lived without activity restriction resulting from a long-lasting physical or mental health condition”. The average woman in the UK can expect to experience 22 years of disability and the average man 17 years (Office for National Statistics, 2022).
Around 95% of the NHS’s annual budget is spent treating disease, and only 5% on preventing disease (Martin et al, 2020). The health of the nation is poor and deteriorating: 63% of adults are overweight or obese. Obesity raises blood pressure and cholesterol and increases the risk of type 2 diabetes; these factors increase the risk of heart disease.
Obesity is linked to a rise in breast cancer in post-menopausal women; it is also linked to an increased risk of bowel, uterine, oesophageal, pancreatic, kidney, liver, upper stomach, gallbladder, ovarian and thyroid cancer, as well as myeloma and meningioma (Department of Health and Social Care, 2020).
The number of people in the UK with diabetes has risen to around 4.3 million, and a further 2.4 million people are at increased risk of type 2 diabetes. Diabetes alone costs the NHS over £10bn per year – around 10% of its budget. Diabetes can also lead to other long-term conditions (Diabetes UK, nd).
We are spending more and more, demand continues to grow, and the health of the nation continues to deteriorate. Adults’ disability-free life expectancy is reducing (ONS, 2022). I fear that the next generation of older people will develop long-term health problems earlier and will experience a poorer quality of life than the current generation. People who ought to be in their prime may experience ill health. An unhealthy population increases demand on health services, and medical staff may end up carrying out complex heart surgery when health promotion earlier in a person’s life could have avoided this. It doesn’t have to be this way.
We will never have enough money or enough staff to meet demand, because we are not spending wisely. We are spending too little on prevention and beginning preventative work too late. We need to integrate health promotion and curative strategies rather than spending most of our budgets on treating preventable disease. We need to enable and encourage people to live well and to age as well as they possibly can.
Strong, robust health promotion that challenges those who advocate poor lifestyle choices will, in the medium to long term, reduce demand and reduce costs. More importantly, it will improve health and wellbeing.
Health promotion is not about a nanny state. It’s about empowerment and enablement; it’s about giving people the tools to live their best lives.
Linda Nazarko is consultant nurse, physical health, West London NHS Trust
References
Department of Health and Social Care (2020) Tackling obesity: empowering adults and children to live healthier lives. gov.uk, 27 July (accessed 15 August 2023).
Diabetes UK (nd) How many people in the UK have diabetes? diabetes.org.uk (accessed 14 August 2023).
Martin S et al (2020) Is an ounce of prevention worth a pound of cure? A cross-sectional study of the impact of English public health grant on mortality and morbidity. BMJ Open; 10: e036411.
Office for National Statistics (2022) Health state life expectancies, UK: 2018 to 2020. ons.gov.uk, 4 March (accessed 14 August 2023).
Scully et al (2021) Obesity, type 2 diabetes, and cancer risk. Frontiers in Oncology; 10: 615375.