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Doctors are told to “make every contact count” to reduce costs of poor lifestyles

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e319 (Published 10 January 2012) Cite this as: BMJ 2012;344:e319

Re: Doctors are told to “make every contact count” to reduce costs of poor lifestyles

The NHS Future Forum has suggested that every healthcare professional should “make every contact count”: use every contact with an individual to maintain or improve their mental and physical health and wellbeing.1 However, although millions of people do talk to a member of NHS staff every day not all of these will be ideal opportunities for talking about stopping smoking or losing weight. For example, a young man who has plucked up enough courage to talk his doctor about a sexual problem will not want to be lectured about quitting smoking. Many doctors already assess the individual needs of their patients with sensitivity and discretion and opportunistic advice may or may not be appropriate. Doctors must be allowed to listen to the individual needs of their patients

The Forum is also keen to refocus the NHS towards prevention and promotion. This is in line with the World Health Organization’s Ottawa Charter for Health Promotion which is a seminal document of the new public health.2,3 However, the Charter also lists other important areas for effective action including building healthy public policy, creating supportive environments and developing personal skills. All these activities are not resource neutral.

Since the early 1990s we have had a few national health promotion strategies and collectively they have over emphasised the individualistic approaches and ignored or under emphasised economic influences on health and the role of social, educational and economic policies to promote health.

Whilst I agree with some of the actions recommended in the Forums report, a final crucial element that is missing is a discussion on the capacity and resourcing of public health.

1 Mooney H. Doctors are told to “make every contact count” to reduce costs of poor lifestyles. BMJ2012;344:e319
2 World Health Organization, Ottawa Charter for Health Promotion 1986, Copenhagen: WHO.
3 Watson, M., Going for gold: the health promoting general practice Quality in Primary Care, 2008. 16: p. 177-185.

Competing interests: No competing interests

16 January 2012
Michael C Watson
Associate Professor in Public Health
University of Nottingham
Faculty of Medicine and Health Sciences, B61c, Queen's Medical Centre, Nottingham. NG7 2HA
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