Prevention is the role of governments, not health systems

We are told that prevention is at the heart of the long-term plan of the NHS, published last week (doi: 10.1136 / bmj.180, doi: 10.1136 / bmj.185). This seems like good news. Prevention is better than cure. But we must be wary of suggestions that the role of the NHS is to prevent disease. As Rachel Chapman and John Middleton point out this week (doi: 10.1136 / bmj.l218), there are many elements of secondary prevention in the plan, but there are also many other calls for limited NHS resources.

What about primary prevention? Unless we invest in this area in the long term, all health services will struggle to keep pace with the rising tide of chronic physical and mental illness. Instead, we have austerity measures and cuts in public health funding by local authorities. Adequate primary prevention means tackling the social determinants of health and the acquired business interests. Unfortunately, although the government speaks well, its actions tell a different story.

Take alcohol. As Alison Douglas and Ian Gilmore (Doi: 10.1136 / bmj.l190) write, the British Secretary of Health, Matt Hanbad, is happy to recognize that alcohol is one of the top five causes of premature death in the United Kingdom and fund interventions to help people with Downs. But he says that he will not consider introducing a minimum unit price, ignoring evidence that it would save many lives and a lot of money. Cowardice? Hypocrisy? Or, as Douglas and Gilmore suspect, the influence of the industry? "Why would Hanbad oppose such a policy now?" They ask. "The alcohol industry was quick to welcome his statement. It would be worrisome for the Health Secretary to listen to the views of these vested interests before those of the health community. "

Of course, industries are directly lobbying governments for their own interests, but their greater impact may be more discreet. In China, as reported by Susan Greenhalgh (doi: 10.1136 / bmj.k5050), funding from a seemingly independent think tank by Coca-Cola has perverted research and government policy by diverting the attention of the government. Coca-Cola's disastrous role in the epidemic of obesity (doi: 10.1136). /bmj.l4).

Even in the best regulated environments, commercial interests will find their way there. NICE works hard to be transparent and without hidden influence, but patient groups can be his Achilles heel. As reported by Kate Mandeville and her colleagues (doi: 10.1136 / bmj.k5300, doi: 10.1136 / bmj.l129), patient groups participating in NICE's evidence review often use commercial support. Most of this money has not been declared; and in most cases, a declaration was not required by NICE.

These are skirmishes in a long and unequal battle. If our governments align with commercial rather than public interests, we can not win.