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Author: Tom Heller

Prevention over cure

Updated Thursday, 3rd August 2006

Tom Heller wonders if prevention might not be better than cure

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Wouldn’t it be great if the NHS suddenly became a health service and not a ‘patch up’ service? How about doing things that keep people healthy rather than waiting for them to become poorly, and then spend all that effort trying to reverse inevitable disease and decline?

Although this might seem an impossible dream, there are people throughout the UK who make healthy living the central feature of their work. Yet they often do this without the support or resources that the ‘disease merchants’ at the other end of the spectrum seem to command. Indeed, it is hard to identify much in the way of expenditure that the NHS actually allocates to keeping people healthy. What, then, would an actual health service look like, and what evidence is there that extra expenditure on innovative, community-based resources would be effective in preventing or at least delaying disease and death?

General Practice throughout the UK seems to have a very limited vision when it comes to health. Of course there are systems for immunising babies to prevent some of the infectious diseases that used to affect children. There are also some screening procedures that attempt to identify diseases such as cervical and breast cancer at an early stage. But apart from that, doctors’ surgeries tend to open their doors and just wait for people to become ill and make an appointment.

The Healthy Living Centre movement is an attempt to turn all this round and to concentrate on those things that we know are effective in maintaining peoples’ health. These ‘health-keeping’ factors have been well researched and we now know that exercise, healthy eating, social networking, artistic and creative activity, sports and group interactions all work! They do not only make people feel better, but actually keep people functioning better throughout their lives and prevent early or premature death.

Although the evidence for the effectiveness of these various health-enhancing activities is well established, the ‘health’ movement is up against some formidable adversaries. There are forces in society that actively make people poorly, that create disease and in whose interests it remains to maintain the bulk of NHS energy and activity on patch-up rather than preventive or self-help projects.

You don’t need me to tell you about the purveyors of cigarettes, fat-drenched fast foods and the power that they command to influence the habits and the health of people, especially young people. All this may sound a bit political, and it is hard to avoid taking a political stance when thinking about health issues.

So, as well as the political activity to try to counteract the things that are making their population unhealthy, what exactly might a new vision of Healthy Living Centres actually look like? How will they operate and who will run them? This is getting ‘political’ again, because one of the central features will be that power has to be re-distributed in order for these centres to work. Local people will have to have the ability to run the activities that they want. This will almost certainly be different in different localities and be dependent on the needs, cultures and preferences of the local community. Decisions of this sort are too important to be left to the usual decision-makers.

Currently, it tends to be the local health service managers and doctors who have the power to set up services, and this ethos simply does not work when trying to engage the community in the types of preventive activity that I have been discussing. For example, setting up an exercise class and then expecting, or even telling people to attend will not hit the spot. On the other hand, using local people to find out what other local people want and need, then asking them to make the contacts and use the resources becomes an entirely different and much more effective project.

An effective Healthy Living Centre needs to be run by, and to be responsive to and accountable to local communities of people. There may well be a community café where fresh, local organic produce will be available at affordable prices. Local people will work here, they will get accredited training which will allow them to get a foot on the employment ladder.


In the waiting room there will be notices about all the other activities for local people to join. Why not join the exercise class, it’s full of people like you; learn to do some pottery in one of the upstairs rooms, or how about getting that old musical instrument down from the attic to join in with the music activities? The dancing sessions sound like fun.

And if it’s fresh air you want, then join up for the health walk - it’s at your pace and you’ll meet up with old friends. The allotments always need people to help at this time of year, and you’ll learn how to grow things in your own garden. With all these potential activities, some people, at least, might find themselves forgetting what they came to see the doctor for – there are better ways of making yourself feel well.

This article was originally published in 2002.


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