Comment: The real NHS crisis no politician dares talk about

By Sarah Hanson

We know Dave jogs and cycles – he's even been spotted body-boarding off the Cornish coast. Ed's healthy image took a hit with that unfortunate bacon sandwich incident, so he's keen to be seen pounding the pathways of Hampstead Heath. Nigel, well…it's anybody's guess how many pints he can throw back on an average day campaigning.

But while each party is desperate to convince voters they will be the ones to save the NHS, no-one is stepping forward with the easiest, most cost-effective solution to start the savings ball rolling: preventative health care initiatives.

And why not? Because who wants to be the sanctimonious killjoy who tells voters to put out their cigarettes, cut back on the pasties (not the Greggs affair all over again!) and get off their backsides. Even if it is sensible, it gives their political opponents ammunition to say, 'It will be nothing but nanny state nagging if you vote for the X party!' Plus, any potential benefits to the NHS budget and patient health outcomes are unlikely to be calculated until years down the line.

Our political leaders need to be bold and visionary, as they were when the NHS was created. We don't need bickering over who loves the NHS more – we all love the NHS – but caring for the NHS starts with caring for ourselves.

Just look at Thanet, Warwick, Dudley and Great Yarmouth, home to some of the most closely contested seats in the county. In each of these areas, obesity, physical inactivity and smoking rates are far higher than the rest of the country.

Likewise, poverty soars far above average and life expectancy is much below the national norm in other key marginal seats such as Sheffield, Norwich and the Wirral.

If even a fraction of Thanet's 68.4% of adults who are overweight started getting involved with walking groups – shown to decrease coronary heart disease, stroke, type 2 diabetes and certain cancers – savings to the NHS could  easily run into the millions. Type 2 diabetes on its own costs £2.2 million per day in England, according to the Health and Social Care Information Centre in 2014.

Or take Great Yarmouth, another seat hotly sought by Ukip. More than half the adults in this constituency, which has swung almost evenly between the Tories and Labour since the 1950s, are overweight, with 29.7% classified as obese.

Yarmouth is a seaside town with wide promenades, cycle paths – and probably the largest concentration of chip stalls in one place. It's little wonder that 18.8% of children in year six are classified as obese. It doesn't have to be this way, but are any political parties addressing easily manageable lifestyle changes that could make a huge difference at both the personal level and to the future of the NHS?

Residents in other key marginal seats struggle with similar issues, including high rates of smoking and inactivity. In Sheffield, where the rate of smoking-related deaths is worse than the England average, men will live ten years less on average, while 24.4% of children live in poverty. That's 23,100 children starting life with the odds – including a healthy future – stacked against them.

Smoking remains one of the biggest causes of death and illness in the UK, but a sedentary lifestyle and lack of physical activity may actually be more deadly. Around half of women and a third of men are damaging their health through a lack of physical activity. In fact, physical inactivity is the fourth-leading cause of disease and disability in the UK.

But it's also expensive, costing the UK an estimated £7.5 billion a year, according to a government report on NHS costs due to poor diet, physical inactivity, obesity, smoking and alcohol consumption.

The British Heart Foundation estimated the cost of physical inactivity to the NHS for 2006/ 07 was:

  • £117 million for stroke
  • £542 million for heart disease
  • £65 million for colorectal cancers
  • £54 million for breast cancer
  • £158 million for type 2 diabetes

The University of East Anglia's (UEA) Norwich Medical School has been conducting primary research in Great Yarmouth and Norwich, to find ways to get people to be more active through increasing the amount of walking they do. The research has shown that joining a walking group provides multiple physical and psychological health benefits. The challenge now is to widen their appeal to those whose health would benefit the most.

Public health areas are not the same as constituencies, but they can provide a health picture of the key marginals that might decide the election:

  • Warwick – 17.6% of women are smokers when pregnant
  • Wirral – deprivation is higher than average and 14,500 children live in poverty with life expectancy for men and women lower than the England average
  • Dudley – 27.8% of adults are classified as obese with physical activity levels worse than England average (more than 50% are classified as inactive)
  • Plymouth – 24% are smokers
  • Norwich – men in the most deprived areas of Norwich can expect to live 11 years less than in the most affluent areas. Children's GCSE attainment is worse than the England average

Why are deprivation and poverty included in a discussion about the NHS? Both good health and physical activity are socially patterned, generally meaning the more affluent and educated we are, the more likely we are to be physically active and also have better health. And it is this difference we should be concerned about – but the Tories and Labour are too busy trying to fend off Ukip (and its drinking, smoking leader) to bother sharing the message that good health starts with an activity that's free and available to almost everyone.

Photo: Thinkstock

These differences start at birth and will persist throughout life unless there is wide-scale action. We have known this for a long while and yet despite all our public health efforts, the gap in life expectancy between the poorest and most affluent communities is widening rather than decreasing.

To affect change across the social spectrum, there needs to be concerted action by all of us. There is a moral, human and financial cost to the diseases caused by physical inactivity, obesity and smoking, and our widening health inequalities. Health professionals and politicians of all persuasions need to take on board the preventative health message and the entirely unnecessary financial burden this places on our health service.

Politicians need to be as bold and visionary as they were when they set up the NHS. The NHS needs to be a health service, not just a sickness service, and we need to commit money up front, even if the benefits are further down the line. Without that the NHS will be bankrupt.

Sarah Hanson is a post-graduate researcher at the University of East Anglia's (UEA) Norwich Medical School, where she focuses on public health and preventative health initiatives.

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