The UK has made ‘Building a National Health Service fit for the Twenty-first century’ one its key five Missions.
Will investing money into the NHS improve health outcomes? Increasing numbers of medical practitioners think not. Health is simply not created by treating disease.
The British Medical Association report, Prevention before Cure, states
‘Preventable ill-health accounts for an estimated 50% of all GP appointments, 64% of outpatient appointments and 70% of all inpatient bed days. Moreover, it is estimated that 40% of the uptake of health services in England may be preventable through action on smoking, drinking alcohol, physical inactivity and poor diet.’
Yet even this 40% figure is a massive underestimate. It does not include iatrogenic disease (disease caused by doctors), side effects of drugs, nosocomial infections (infections caught in hospital) and the lack of benefit of many medical interventions (many drugs administered simply don’t have a positive impact on the patient).
Here are some interesting statistics:
- adverse reaction to drugs accounts for around 10% of hospital admissions;
- many drugs have no positive impact on the patient as illustrated by ‘Net Number to Treat’ such as in the case of statins where the vast majority of people on the drug will not benefit;
- drugs have very different effects in different people and this is not appreciated sufficiently, leading to adverse outcomes; and
- research is heavily funded by pharmaceutical companies which skews medical knowledge.
Very few new (and expensive) drugs are better than previous ones and there is high risk of serious, unpredicted outcomes with new drugs and even a negative impact overall as reported in New Scientist and The Lancet. The complex interactions between drugs is also highly problematic.
Our understanding of how the body works has also been changing. We now see the body as an ecosystem and understand for example how ‘good bacteria, fungi and viruses’ in the gut positively impact our health. We know now how antibiotics can destroy the gut biome which has major impact on physical and mental health.
There are even wider implications of not taking a more holistic perspective. We might call these ‘externalities’ for medical practice. For example, with such a highly medicated population in the UK, and with these drugs being excreted and endings up in waterways, water is now a cocktail of pharmaceuticals, making drinking water unsafe.
Promoting health means creating the conditions which generate health – healthy food systems, a clean environment, strong communities, less social inequality, connection to the rest of nature and a stable climate. Disease is best thought of first as a symptom of an unhealthy system. We need to see the bigger picture, understand how everything is interconnected and take a systems approach to promoting health.
I asked a friend of mine, a professor of public health: ‘Trevor, I reckon that 80% of medical spending is avoidable. Can that really be true?’
His reply: ‘Sounds about right.’