26 October 2016

Prevention is better than cure Dr Judith Richardson, programme director of quality & leadership at NICE

Judith talks about the importance of investing in public health.

Can we take full responsibility for our own health? We ultimately decide what food to eat and the level of exercise to take. But what if we have restrictive food allergies or a mental health problem means we struggle to get to the gym?

Public health campaigns aim to empower people. By investing in services, which ensure people have access to the facilities they need we can support their wellbeing and prevent future illness.

We all know that health and social care budgets are tight, and that the pressure on resources is going to increase further as our ageing population grows. Prevention programmes are one area where spending money now really can save us money in the future.

I recently attended Public Health England’s annual conference, where I took part in a discussion about the cost effectiveness of programmes to prevent ill-health. It was great event. I was inspired to hear how colleagues working on the frontline of our health service are embedding the promotion of healthy living into their everyday work.

One example that struck me came from a psychiatrist in Birmingham. Physical health can often be overlooked in the face of severe mental illness. Therefore, it was encouraging to hear him discuss the support given to people to exercise whilst in hospital. This is very important when you consider that some of his patients may be admitted for up to two years.

So how can NICE support the prioritisation of public health programmes when budgets are being cut? After all it’s tempting to spend our money tackling problems that already exist, rather than preventing the problems of the future.

A main point to make here is that our guidance identifies and outlines what works. We assess each programme to ensure it is cost effective, and it is encouraging to note that most public health programmes are cheap and very effective.

NICE have developed three return on investment tools for tobacco, alcohol and physical activity. These aim to help local organisations map out how much money they could save in the long-run by investing in healthy-living programmes now. We plan to publish two more tools focusing on mental health and children shortly.

One of the best things about public health programmes is that they are supportive. They do not rely on costly drugs or complex technologies. And they do not place blame on the individual, instead they seek to work alongside them to improve their wellbeing.

By ensuring the programmes are based on solid evidence, have a positive impact and deliver value for money we can use them to prevent future pressures on the health and care system.  


  • If we encourage people to know their blood clot risk and improve time to diagnosis of acute VTE we would reduce the current poor outcomes for blood clot patients.

  • About human rivhts for exercise and poor mobility
    I am a GP and Friend of a local Park. The council parks department manager thinks 100m of up and down tarmac is acceptable for lo als. Our other paths are muddy uneven and often under water. Please set out a must do to force miserable managers to improve disability access for all locals as we have spent 2.5 years failing with our council office.

  • I found this a disappointing article. If we really want people to live healthier lives, we need to influence the environment they live in as much, if not more, than their individual decisions. How can people use active forms of transport if traffic planners plan for the car, instead of for walking and cycling? How can they eat healthily if town planners don't ensure housing estates have food outlets that sell something other than chocolate and fast food? How can they breathe clean air while air quality exceeds legal limits in our cities? I'd like to see NICE allocating responsibility to policy- and decision-makers. A focus on the individual may not be the most cost-effective way of using our limited resources. It could even be seen as blaming the victim.

  • The prevention of the worst consequences of medical conditions/diseases should also be a goal. As an example. Although much is written about lifestyles needing to be more active in order to reduce the risk of getting Type 2 diabetes, once someone has diabetes it is possible to manage it so that patients are at substantially less risk of both its short and long-term complications (which is where the costs of the condition lie). For those on intensive insulin therapy, which should basically be all those with Type 1 diabetes, managing diabetes means managing blood glucose levels 24/7. Technology now exists that enables patients to monitor their own blood glucose levels continuously and take the appropriate action in terms of insulin dosing, level of exercise or glucose intake to tightly control their blood glucose levels, thus reducing costly complications. As such one wonders why NICE has not more clearly backed the use of continuous glucose monitoring systems for such patients as above.

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