What is prevention?

Prevention is an idea we can all get behind. It’s a sensible approach. Stop the fire before it starts rather than waiting to douse the flames. Prevention has long played a role in our national health strategy, but it has never been centre stage, despite repeated calls to rebalance focus between prevention and treatment in successive NHS plans and expert reports.

Now though, something feels different. Prevention is climbing the priority list – more talked about in Whitehall and among health experts and more visible in the media. When preventable illnesses are the leading cause of early death and disability and cost the NHS billions each year, it is not surprising that placing greater focus on prevention has become a pressing concern. 

Prevention in health is about trying to reduce the risk of illness and injury before they happen by taking prompt action that stops them entirely, or catches them in their earliest most treatable stages. Preventive health takes many forms and examples include measures like banning smoking in pubs, vaccinations and making seat belts obligatory in cars. 

Humans have been acting to prevent disease and infection since ancient times, and the role of environment and lifestyle in this is acknowledged in numerous historical texts. Early methods to prevent illness included practices like exposing individuals to disease to build immunity; attempts to prevent smallpox in this way are recorded as early as the 15th century. This eventually paved the way for launching mass smallpox vaccination in England and Wales in 1853.

Another early example of preventive health came in 1756, when James Lind’s clinical trials showed that scurvy in British sailors – which is caused by prolonged vitamin C deficiency – could be prevented by simply adding citrus fruits to their diet during long voyages. 

What is the UK’s track record on prevention?

We already know the value that prevention can deliver. Introducing smoke-free legislation, which banned smoking in enclosed public spaces and workplaces, led to sharp drops in hospital admissions for heart attack (2.4%) and asthma (5%) in its first year alone. The human papillomavirus vaccination programme for adolescents has resulted in a 90% reduction in cervical cancer among young women. This has led to socioeconomic savings equivalent to £210,000 per case avoided (eg, NHS and productivity costs). Notably, these gains do not account for the broader quality-of-life gains or reductions in premature mortality.  

But despite many successes, the UK’s prevention efforts are falling short of meeting our current challenges. Delivery is often piecemeal, with measures introduced in isolation and lacking sustained nationally coordinated implementation. We also lack a national prevention framework that is shared across government and the healthcare system, and which brings together evidence and expertise on what works best and is most cost effective to prevent the conditions most impacting our health outcomes. 

The fact that our health is deteriorating and the NHS is buckling under the strain of treating illnesses that could be avoided is evidence enough that we are failing to capitalise on prevention. We are not short on evidence. We already know how to prevent many of the illnesses that place the greatest burden on our health and economy. Yet despite having the tools we are not using them at scale or with sufficient urgency.

Barriers to prevention

There are several reasons why focussing on prevention is challenging. Prevention has not been treated as a strategic or financial priority and we do not articulate the long-term benefits of prevention or the trade-offs needed to realise it. Just 5% of NHS spending is allocated to prevention and the Public Health Grant, the key mechanism for funding prevention via public health initiatives, has fallen 28% in real terms since 2015. 

The returns on prevention are long-term, but the public and policymakers alike often discount future gains. The government needs to get better at communicating these long-term benefits and be open about the trade-offs needed for the upfront investment in prevention we need.  

Finally, prevention also has a public relations problem. When it works well, bad outcomes are avoided before they even happen – making its benefits less visible. At the same time, prevention policies have often faced pushback on the grounds of representing the ‘nanny state’, meaning they’re undervalued by the public and require significant political effort to push through. However, the tide may now be turning on public attitudes. Recent polling suggested 65% of British adults support a ban on junk food advertising in public spaces while over 70% see a role for employers in the health and wellbeing of their staff.