Helen Salisbury: An illusion of control

We’ve been shaken recently in our surgery by some unexpected diagnoses and sudden deaths that have reminded us of how poor doctors can be at predicting the future health of patients. With some people you can see a downward trajectory, signalled a long time in advance—although even then they may surprise you, recovering from yet another acute admission or infectious exacerbation and carrying on for many more years. But there are others who were seemingly in the peak of health and fitness and are suddenly gone.

Most people understand the things they need to do to stay healthy. The messages patients get from their doctors haven’t changed much in 50 years: don’t smoke, exercise regularly, limit your alcohol intake, and maintain a healthy weight. Also, accept the vaccinations you’re offered, check your blood pressure, and attend cancer screenings. On top of these basics, many private health screening and “wellness” companies are suggesting that people “take control of their health” by having additional tests to detect abnormalities before they become serious, although evidence for this being beneficial is limited.1

The brutal fact is that our health is determined by many things we can’t control. We don’t choose our genetic inheritance and can’t influence the material circumstances we grow up in. The availability of good food and safe places to play outside may determine a lifetime of healthy weight or obesity, and physical and emotional security in childhood has a huge impact on our future mental health.23 So, perhaps we should stop focusing obsessively on what we need to do for our personal health, as we already know that beyond the obvious basics, the rest is mainly luck and inheritance.

Of course, I’m not suggesting that we should halt the scientific research that may lead to medical advances and turn some of those devastating diagnoses into treatable conditions. Rather, to benefit the generations coming after us we should harness what we already know about the social determinants of health, thinking about how we can improve the circumstances children are experiencing as they grow up today.

A report from the Joseph Rowntree Foundation last week showed that seven million UK households were going without essentials, and 5.4 million were living with food insecurity.4 More than 151 000 children are living in temporary accommodation.5 Ending child poverty would be the biggest step any government could take to improve the nation’s health.

The focus on prevention that we’ve been promised in the NHS shouldn’t just be about asking patients to take control of their own health through lifestyle changes: it should also work on intervening at the earliest stages to ensure that today’s children have an opportunity to grow up healthy and happy.