Benjamin Franklin famously said, “An ounce of prevention is worth a pound of cure.” Yet, this principle has proven difficult to implement within the current structure of the NHS. A significant concern highlighted repeatedly is not merely the per capita expenditure but also the timing and allocation of these funds. In England, the NHS has been increasingly channeling its budget towards acute hospital care—providing treatment for individuals who are already quite ill—while financial support for primary care services, like general practitioners, has diminished.
This trend results in the NHS focusing more on treating severe and costly health issues rather than investing in preventative measures. Substantial resources are directed towards managing conditions such as heart attacks and strokes, rather than identifying high-risk individuals and intervening early to mitigate their chances of developing these illnesses.
Against this backdrop, the announcement that the NHS in England will offer complimentary cholesterol screenings and blood pressure checks at selected high street pharmacies for individuals aged 40 to 84 is particularly encouraging. This initiative will be rolled out in phases nationwide, building on a pilot program conducted in North London where nearly 2,500 patients were assessed at 61 community pharmacies. The results showed that 19% of those tested were identified as being at heightened risk for heart attacks or strokes and were subsequently given advice or referred for further medical evaluation.
This initiative is a commendable policy decision: it is user-friendly, cost-effective, alleviates the burden on GPs and hospitals, and most crucially, it has the potential to decrease preventable illnesses and fatalities. Extensive population studies have provided us with reliable data regarding the risk factors associated with severe health conditions like heart disease, type 2 diabetes, and various cancers.
The variety of health tests available can be overwhelming, especially with numerous private companies promoting “health checkups.” However, drawing from both my public health and personal training experience, I believe that a limited number of straightforward, low-cost tests can yield a valuable overview of an individual’s health and indicate whether lifestyle changes or medical interventions are necessary. Implementing an annual health check in community pharmacies would not require extensive resources.
To begin with, blood pressure testing is essential; it provides insight into the pressure exerted by the circulating blood on artery walls and the cardiovascular system. High blood pressure, often referred to as the “silent killer,” can cause significant internal damage without any visible symptoms.
Next, measuring waist circumference is important. This metric is not about appearance but rather about the health implications of fat distribution. Visceral fat, located around the abdominal organs, is linked to conditions such as hypertension, insulin resistance (which is related to type 2 diabetes), and heart disease. Ideally, waist measurements should be less than half of a person’s height.
A cholesterol finger-prick test, similar to what is currently being offered, is another critical assessment. Understanding cholesterol levels can help determine long-term cardiovascular risks and whether dietary modifications or medications, such as statins, are needed to lower LDL (the harmful) cholesterol levels. Additionally, including a glucose or HbA1c finger-prick test could be beneficial. This test measures average blood glucose levels over the previous two to three months, helping to identify those at risk for diabetes. Like hypertension, pre-diabetes and early-stage type 2 diabetes often present without symptoms, making testing vital for early detection.
Finally, I would advocate for a fitness evaluation. While there are various methods to assess fitness, a simple one-mile brisk walk on a treadmill, coupled with a test of how many push-ups can be completed in a minute, can provide valuable insights. The walking test gauges cardiovascular fitness—how effectively the heart, lungs, and muscles work together during physical activity—while the push-up test assesses muscular strength and endurance, both of which are indicators of overall health and longevity.
Combining these health metrics with information about smoking habits, alcohol consumption, age, and family medical history would create a comprehensive yet accessible overview of an individual’s health status. Although implementing such testing in pharmacies would incur some costs, it is likely to result in overall savings for the healthcare system by preventing illnesses and the associated high expenses of treatment.
Beyond financial considerations, many individuals may remain unaware of serious health issues, such as being pre-diabetic or having hypertension, until they require hospitalization or experience significant symptoms. This underscores the importance of preventive healthcare measures. Just as we have mandatory annual car MOTs to avert hazardous breakdowns, it stands to reason that we should prioritize similar preventative measures for our health.
Professor Devi Sridhar holds the position of Chair of Global Public Health at the University of Edinburgh.
