In this month’s emotive opinion battle, we ask two healthcare professionals if we should be encouraging patients to evaluate their lifestyle choices, or are their bad habits relieving the NHS burden?
Dr Justin Varney
National Lead for Adult Health and Wellbeing at Public Health England
As healthcare professionals our job is to support individuals to achieve their potential in life.
Approximately 40% of preventable mortality and morbidity is the result of lifestyle risk factors like inactivity, smoking and diet. The Global Burden of Disease study demonstrated that lifestyle risk factors continue to drive the burden of years lived with health-related disability. Furthermore, as life expectancy expands in England so has the proportion of life lived with a health condition.
As clinicians, we integrate prevention into routine clinical practice when producing a treatment and management plan. This prevention-focused approach is evidence-based and supported across NICE guidelines as being beneficial for patients on a short- and long-term basis.
Work by the Richmond Group of Charities found that patients with long-term conditions need healthcare professionals to give them ‘permission’ to be physically active and reassure them that it will be beneficial. This reiterates other research which highlights that HCPs are key influencers for changing their lifestyles.
At an economic level, integration of prevention into routine clinical care is fundamental to shifting the population burden of ill health and ensuring the financial sustainability of the NHS. At almost every stage of life, becoming more active, stopping smoking or eating healthily can improve quality and quantity of life, so why deny patients?
Supporting patients to make lifestyle changes can be as simple as taking a brisk walk every day or receiving encouragement from an HCP. There is increasing evidence that when these nudges are integrated into clinical consultations they deliver real change for the patient and help them live healthier for longer.
Dr John Giles
Medical Director at Benenden Healthcare Society
Calls for extra financial contributions or the rationing of care for smokers and drinkers are somewhat misplaced and usually come from those who abstain. This overlooks the much greater contribution smokers and drinkers make to the UK economy. Approximately £50 billion, around 30% of the total NHS budget, is raised from excise duties and, even after any increased costs relating to patient misuse, this produces a substantial net gain to the economy.
Smokers are more likely to die prematurely, and relatively cheaply, from lung cancer or heart disease and, in so doing, are less likely to require other medical specialties, such as long-term dementia care.
Similar arguments are now being deployed against the overweight and obese. There is little doubt that those considered obese (BMI >30) are more likely to incur above average healthcare spending as a result of associated conditions like diabetes, heart disease and cancer.
We are all living longer! Medical advances inevitably lead to increased costs overall. Every life ‘saved’ with a new drug or treatment will not result in any financial saving. Lives are never really saved – we all have to die sometime. We are simply prolonged.
Improvements to lifestyle, reduced smoking rates and other preventive measures now mean fewer individuals die prematurely; they can expect to survive, requiring multiple interventions in later life – new joints, cataracts and probable cancer treatments. Half of us are now likely to be diagnosed with cancer during our lifetime. This improved longevity, while welcome, simply leads to greater expense as we age.