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Health Checks: Do They Work or are They a Waste of Time and Money?

Posted on Aug 26, 2013 by Sergio Ulloa ()  | Tags: England, health checks, Healthcare, public health england, UK, uk public health

A  national programme of regular health checks operated by the UK public health authorities has been called into question by both independent research and the Royal College of General Practitioners, which represents doctors responsible for primary care.

Public Health England, which has oversight of all issues relating to public health, recently reported a review of the Health Check programme (in operation since 2009) and concluded that their overall policy was based on tackling avoidable deaths and disability, as well as reducing health inequalities in England. Their current intention is to extend the scale of the programme by encouraging local authorities to commission health checks in their areas with the goal of screening some 15 million people in England over the next five years.

This policy of health checks is seen as a method of supporting other significant aspects of health care policy  in  reducing  premature mortality and in particular, the issues associated with heart disease and diabetes, as well as the contribution that excess body-mass characteristics can have towards early death.

The NHS Health Check is a national programme for those aged 40 to 74 living in England who do not have any current circulatory problems  and who are not receiving any 'management' of key  risk factors. The goal of these health checks is to ultimately lead to the prevention of heart disease, stroke, diabetes and kidney disease and also to raise awareness of dementia for those older participants aged 65-74. The overall intention of the programme is that a Health Check will be available to everyone eligible every five years.

Checks will focus on what has been identified as the seven principal causes of preventable mortality; high blood pressure, smoking, cholesterol levels, obesity, poor diet, physical inactivity and alcohol consumption.

The benefits and consequences of the health check programme have also been identified. If these are successful, it is estimated that every year the programme can, on average, insure that:

1,600 heart attacks are avoided thus saving 650 lives

4,000 fewer people become diabetes sufferers

At least 20,000 cases of diabetes or kidney disease  are detected earlier than would otherwise be the case

Given all of these apparent benefits, it seems surprising that general practitioners are expressing significant misgivings about the programmes recent relaunch and the ambitions to greatly extend its take up. However, their concerns relate to the fact that those who present themselves for these health checks tend to be those who already have an active interest in their own continuing health and well-being while those more at risk tend not to engage.  There is a concern that the checks may even generate greater anxiety among those middle aged and older people who are in fact least at risk.

The GP leaders argue that the money spent on promoting and delivering health check programmes would be better spent on more specific initiatives, such as plain cigarette packaging and unit pricing for alcohol, which they feel would bear down more effectively on the health risks associated with these lifestyle choices. These are both areas where UK Government moved very recently from a position of introducing such changes to delaying, if not abandoning, their own initial proposals.

The GPs position draws on research published by a Danish organisation, the Nordic Cochran Centre which, last year reviewed the operation of these health check programmes across a number of countries and over a period of time - though it did not cover this UK programme which has only operated since 2009.

The essential conclusion of this work did not suggest that there was any significant reduction in deaths from heart disease or from cancer as a result of the health check programme. Nor were there effects  that could be seen in admissions to hospitals or referrals to specialists, time lost from work or more visits to the doctor. The Danish researchers speculated that one reason for the apparent lack of impact might be the extent to which problems were picked up in the course of other consultations with GPs, together with the possibility that those most at risk were not seen regularly by their doctors.

Public Health England have acknowledged that the health check programme is not supported by rigorous and authoritative research but they argue that the impact of lifestyle choices on health is so significant that there is an urgent need for action to address it and that the health check programme is in fact a necessary response.

However, there are proposals to set up a panel of experts which will have a continuing responsibility to review research and evidence on the efficacy of this approach and also to undertake separate research into this area to conduct other work that will evaluate the economic benefits of the programme in the light of experience.

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