“Prevention saves lives and saves money,” said Health and Social Care Secretary Matt Hancock as he addressed the International Association of National Health Institutes’ conference in November1. He was speaking against the backdrop of the Prime Minister’s ‘Ageing Grand Challenge’ initiative, launched earlier this year, which aims to increase healthy life expectancy by five years in 2035.
“Too much of the health debate in England has been about our rights: what we deserve, and what the NHS can deliver. But, I think we need to pay more attention to our responsibilities, as well as our rights,” he said.
He told delegates: “I want to see people taking greater personal responsibility for managing their own health...Because focusing on the responsibilities of patients shouldn’t be about penalising people but about helping people to make better choices.”
By maximising the potential of rapidly developing artificial intelligence and genetic screening technology, the Health Secretary said he wants to enable earlier interventions to diagnose the future health risks individuals may face. At which point, either the right preventative treatment can be prescribed or changes to lifestyle can be adopted.
This, he said, would help eliminate waste and save valuable NHS resources for those who really need them.
The role of the workplace
The Department of Health also believes the workplace is the right place to reach people with important healthy lifestyle messages.
These are salutary messages for employers too, which could also reap benefits in terms of both HR costs and the overall bottom line. Experts have long advocated the need to help employees mitigate mental and physical ill-health, intervening early to maintain a healthy and, consequently, a more productive workforce.
However many, along with the Government, suggest that employers also need to be focused on prevention, as well as reacting to individual needs.
Why? Because modern life is such that people are moving less, with upwards of 40% of individuals in many countries failing to do even moderate activity, defined as just 150 minutes per week2. This is a big problem, as the negative impacts of a so-called ‘sedentary lifestyle’ are well known.
So are the negative impacts of being overweight, but the prevalence in many counties of individuals with a BMI of 25+ has reached 40-60% (even higher). Add to these a rise in binge drinking, persistent smoking rates, pervasive stress and more time spent in direct sunlight. All of these things have contributed to a significant upward trend of non-communicable disease (NCDs) – otherwise known as lifestyle related diseases.
The impact on health outcomes is serious. In 2017, over 70%3 of deaths were related to NCDs.
Furthermore, with people working towards a later retirement age (rising progressively to 68 for both men and women by 2028) employers have a duty to help everyone stay well, fit and productive until later in life.
Prevention: evidencing value
There is already evidence that a preventative approach is not only possible but is delivering. For example, VitalityHealth’s member data shows that claims costs decreased by up to 33% when physical activity levels increased.
In addition, research carried out in conjunction with RAND Europe, shows that the Vitality Programme is helping people improve their life expectancy4.
Vitality Age is an indication of an individual’s health status, and the long-term life expectancy impact of this, based on a range of lifestyle and clinical health factors. While a small Vitality Age Gap is normal (approximately 90% of individuals’ Vitality Age is older than their calendar age) a high gap indicates an individual at more severe risk of ill health. When their Vitality Age Gap was analysed, employees who engaged with the programme were shown to be in better states of health than those who did not engage.
Employees who were highly engaged in the programme had an average Gap of 1.9 years, approximately two thirds lower than those with no engagement, with a gap of over 5 years.
Significantly, the results show that even a low degree of engagement with the programme can have a significant impact on health – Vitality Age Gap almost halved for individuals with low or moderate engagement, when compared to those not engaging at all.
The study also able to identified improvements to specific health risks over time, as engagement with the Vitally Programme increased. Between 2014 and 2017, the proportion employees with poor nutrition dropped by 7%, physical inactivity by 33% and smoking by 15%.
Equality of access matters
Any employer prioritising prevention must, of course, ensure equality of access to all employees, ensuring that their strategy and associated communications appeal to all: whatever their age, sex or socio-economic status.
Various research, including from Public Health England5, indicates that people lower down the socio-economic scale experience health inequality. Their environment and economic conditions invariably act as barriers to changing behaviours, such as eating healthily, getting more exercise and quitting smoking.
Whilst the workplace might be the obvious environment to begin influencing those behaviours, such potential health inequalities must be considered.
Communication is vital. The biggest challenge comes in turning the message into positive action. This may involve adapting the actual workplace environment: for example, changing the canteen menu to offer healthier nutrition choices; and providing more facilities - and impetus - to encourage physical exercise.
Undoubtedly peer group influence at work will also represent a major factor. In that sense, access to gamification techniques, as part of a company-wide recognition programme, could help reap rewards for all.
1 Prevention is better than cure – Matt Hancock’s speech to IANPHI, Department of Health & Social Care (Nov 2018) https://www.gov.uk/government/speeches/prevention-is-better-than-cure-matt-hancocks-speech-to-ianphi
2 Global Health Observatory Data, World Health Organisation [Accessed Nov 2018] http://www.who.int/gho/map_gallery/en/
3 Noncommunicable diseases, Global Health Observatory Data, World Health Organisation [Accessed Sept 2018] http://www.who.int/gho/ncd/en/
4 Shared Value in the Workplace: The Vitality People Study, VitalityHealth (Sept 2018)
5 Health profile for England: 2017, Public Health England (July 2017) https://www.gov.uk/government/publications/health-profile-for-england