Smoking, drinking, diet and lack of exercise needs to be addressed, NHS Future Forum warns
The NHS Future Forum's suggestion that health professionals should routinely talk to patients about their smoking, drinking, diet and exercise habits is born of the brutal truth that more people are harming and killing themselves with their lifestyles.
Obesity, diabetes and alcohol-induced damage are not ticking timebombs, they are exploding already. The number of people in the UK with diabetes has risen by almost 130,000 to 2.9 million in the last year. That is up by almost 50% in just four years (2006-7 to 2009-10). Some 90% of these 2.9 million have Type 2 diabetes, which almost always develops in people who are very overweight.
The Lancet medical journal has conservatively estimated that, on present trends, by 2030 obesity in the UK will have produced 5.45m cases of diabetes, 330,000 more people with coronary heart disease and stroke and 87,000 extra cases of cancer, which together will mean a loss of 2.2m quality-adjusted life years in the population, and costing the NHS another £2.2bn a year on top of the existing huge price of tackling obesity-related illness.
Alan Johnson, then health secretary, described obesity in 2007 as a problem "on the scale of climate change". Other consequences of unhealthy behaviour, like chronic breathing problems caused by smoking and livers damaged by excess alcohol consumption, may be not as on the same scale, but also involve human misery.
The economic price, as measured in lost productivity, welfare payments and the cost to the NHS, are already mind-boggling. Diabetes costs £10bn – almost a tenth of the entire health budget. That includes £725m spent on drugs for diabetics, and the cost of hospital beds – one in seven is occupied by someone with the condition. Yet every expert believes that, without a major change in human behaviour (which no one expects), these costs will only rise.
The paradox, if that is the right word, is that the casualties from these lifestyle diseases have been increasing at the same time as the risks of unhealthy behaviours have received unprecedented attention. Everyone knows that cigarettes are ruinous, but one in five still smoke.
Yet, as Professor Steve Field who chairs the forum admits: "Not enough people take enough responsibility for their own health, despite the amount of information that's available on how important it is not to smoke, not to drink excessively, to eat healthily and to take exercise."
But while experts agree that we can't go on like this, no one really knows what to do. While bans, price rises and "de-normalisation" reduce smoking, there is frustratingly little evidence about possible solutions to the alcohol and, especially, obesity epidemics.
The forum's thoughtful, quietly radical report is a welcome attempt to provide an answer.