The extension of life expectancy in the 20th century was supposed to be one of the greatest societal opportunities in modern Britain.
But although the longevity dividend bought valuable health and economic gains for individuals and societies, it has long ceased to pay out: instead of living longer, healthier lives, we are an increasingly sick nation where we live longer, but in worse health.
Experts say our longevity is now helping to bring the NHS and the economy to its knees.
Authoritative figures are increasingly turning to the idea of prevention rather than cure: a substantial report by the Tony Blair Institute for Global Change (TBI) in July will show the huge impact that investing in health prevention could have on the economy.
“When you’ve got nearly 3 million people off work with ill health, it’s pretty obvious what the macroeconomic effects are,” said Andrew Scott, who wrote the forthcoming TBI report on the economics of longevity. “The real value of preventive health is long term.
“It’s exactly like compound interest. If you start preventive health interventions early, the economic gains are about four times larger than if you start later,” said Scott, author of The Longevity Imperative and co-author of The 100-Year Life.
Long-term sickness is the main reason why economic inactivity in the UK rose to a record 9.4 million – or 22.2% of adults aged 16 to 64 years – in February 2024, costing the economy £43bn a year.
And at least 80% of the health inequality outcomes in the UK are driven by chronic yet potentially modifiable diseases. Only 9% of men and 16% of women born today can expect to reach pension age in good health.
The NHS is less equipped to either prevent or manage diseases during their early stages.
Prof Sir John Bell, a renowned immunologist, said: “The NHS has done nothing – and by nothing, I mean nothing – to look after people who are obese, even though we know obesity is probably the major risk factor for cancer, heart disease, strokes, diabetes.”
Although we live in an environment that exposes us to significant risk, it often takes a significant health event – often in the 60s or early 70s – for symptoms of big diseases to become apparent. By this time it is often too late to turn things around.
But given it is impossible to treat the whole population at 35, experts say we need to get better at predicting which asymptomatic young people are likely to be in trouble in later life through blood tests, family history and genetics.
“We need a prevention service because the NHS can’t deliver this stuff,” said Bell, a trustee of Our Future Health, the UK’s largest-ever health research programme to diagnose and treat diseases early – or even prevent them from developing. “It needs to be done in the community, at low cost, with high throughput.”
Prof John Deanfield, who was asked by the government last year to set up a taskforce to identify radical new approaches to prevent cardiovascular disease and reduce pressure on the NHS, has had enough of tinkering with the current health system. Instead, he has recommended the creation of not a parallel NHS, but a pre-NHS.
He envisages a system of one-stop health clinics in offices, football grounds, leisure facilities and supermarkets where people can have their health assessed, treatments prescribed, their progress monitored and motivation coached – all without having to go into the traditional medical system and, ideally, keeping them so healthy they don’t need to.
Deanfield is not alone. There is a wave of support for the “prevention rather than cure” approach: Dr Charlotte Refsum, director of health policy at the TBI and a former GP, is about to release another report on prevention.
“The NHS tries its best but we think about health spending in totally the wrong way,” she said. “The health of our labour force is a national asset: it’s our means of production. We should be keeping that asset happy, healthy and working but what we actually spend our money on is preserving people in the last year of their lives.
“We need two services,” she said. “The NHS and GPs managing chronic long-term conditions – and a health prevention service running alongside that.”
Deanfield’s taskforce included Sir Keith Mills, inventor of the Air Miles and Nectar Card loyalty card schemes.
Mills argued for people being rewarded for improvements in their health with free tickets for football matches, gift vouchers, days out, supermarket discounts for healthier food or cinema tickets.
“The biggest problem within this preventive space is behaviour change,” said Mills. “You can have all the diagnostics and technology you like but if people don’t do what you want them to do, it’s all a waste of time and in the health sphere, we don’t currently incentivise people to look after themselves at all.”
He also suggested that the government could reward organisations that can show they have successfully reduced the blood pressure, weight or cholesterol of their employees, fans or customers – with carrots ranging from official recognition to tax benefits.
“We can’t go on as we are now, and the solution isn’t more doctors and nurse,” he said. “We have to alter the way in which people live.”
Deanfield believes that, this time, the government will listen. “It has become a political imperative because health is now wealth in a very, very big way,” he said.
• The caption below the image accompanying this article was amended on 23 July 2024. An earlier version referred to diabetes as an often preventable long-term illness when “type 2 diabetes” ought to have been specified; type 1 diabetes is not preventable.
