• By Dartington SRU
  • Posted on Wednesday 17th February, 2010

Prevention goes green in vision of 2025

Among the papers lately published as part of the UK Marmot Review of Health Inequalities is a circle of blue sky thinking from "Task Group 5" which fuses the logic of prevention with the sustainability agenda.The Task Group's review ranges across the environmental components of well-being to discuss green space, transport and food systems – and, for good measure, it throws in a "vision" of a braver new world in 2025."After the budget cuts of 2011-16, the architects of the health system recognized that it could never meet the insatiable needs and wants of a population hooked on medical interventions," the scriptwriting team imagines. "The model shifted rapidly towards prevention." "General practitioners play a central role as health leaders in their communities. Working with other health professionals and teachers, they help children and their parents to gain a full understanding of what makes for good health and encourage a personal commitment to maintaining it."Taking vision still further towad the point of hallucination, they add: "This new focus on prevention and efficiency means that, despite falling budgets, healthcare remains free at the point of delivery – a matter of great national pride and interest to other countries now trying to emulate the UK model." In the detail, Task Group chairman Jonathon Porritt and his colleagues identify a key role for expert local service hubs, echoing arguments for a new breed of "strategic practitioner" published last year in work funded by the Nuffield Foundation. [See: Time is ripe for the barefoot preventionist]Come 2025, they reckon, the new approach will have accelerated the building of Local Service Hubs, where citizens can obtain advice and assistance on health, security, work, money and family matters, and also "co-creation centers" where they can volunteer, advise others, socialize, exercise, and participate in decision-making."Participation includes active groups of 'citizen scientists', who undertake to research a subject in depth, and then help people in the community to understand what's really going on. This includes ethical debates on the use of gene therapies and nanotechnology, and on the allocation of budgets."The journey to the promised land, the Task Group argues, rests squarely on a redefinition of prevention and public health."The National Health Service cannot single-handedly improve the health of the population. Instead, this needs to be a shared responsibility, with a range of different sectors and services working together – education, employment, planning, housing, benefits, transport, sport and leisure, and environment."Proof of that necessary concatenation of effects is the prevalence in 2010 of vascular disease and the damage done by an obesogenic environment (energy-dense food + motorized transport + sedentary lifestyles).Investment in first contact primary care services will be vital, the argue. US research had shown its beneficial impact to be greatest in areas of high income inequality. The greater the supply of primary care physicians, the lower the total mortality at US county level.So community-based treatment services find a place at the heart of the 2025 vision – and for some less familiar reasons:"'Care closer to home' implies less travel and less unequal access, and is a robust model in terms of ensuring long term viability of the health system. Much of the hospital care that tends to be high carbon can be undertaken in community settings, resulting in lower carbon pathways."And, by this roundabout route, there is commendation of role taken by UK Health Visitors in leading and delivering initiatives such as the Healthy Child Programme using a family focused public health approach, and also for the introduction into the UK system from the US of Family Nurse Partnerships.ReferenceShi L, Macinko J, Starfield B, Wulu J, Regan J, Politzer R "The relationship between primary care, income inequality, and mortality in US States, 1980-1995". J Am Board Fam Pract 2003; 16(5): pp 412-422.• The Strategic Review of Health Inequalities in England was commissioned to advise the UK Secretary of State for Health on the future development of a health inequalities strategy, by taking into account the best global evidence from the WHO Commission on the Social Determinants of Health, and the work of the last ten years. Documents and launch conference proceedings are available online.

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