What are the best societal investments for improving people’s health?BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3377 (Published 30 August 2018) Cite this as: BMJ 2018;362:k3377
All rapid responses
There seems to be no mention of easy access to, and efficient provision of, contraception.
As long ago as 2006 Mavranezouli and Wilkinson published a paper entitled Long-acting reversible contraceptives: not only effective, but also a cost-effective option for the National Health Service. The position has not changed since, and guidance from Public Health England in August 2018 concludes:_
When considering total cost savings across the public sector (including both
healthcare and non-healthcare cost savings), the ROI is £1.86 after one year
(exceeding break-even) and £4.64 over 5 years. Over 10 years, the ROI is
£9.00, or in other words, there is an £9.00 saving for every £1 invested in
publicly provided contraception.
At a time when contraceptive service budgets are under threat, should this not have been included?
1)Long-acting reversible contraceptives: not only effective,
but also a cost-effective option for the National Health
Ifigeneia Mavranezouli, Christopher Wilkinson; J Fam Plann Reprod Health Care 2006: 32(1)
Competing interests: I am a retired SRH consultant, still active clinically and in the Faculty of Sexual and Reproductive Health
Having recently moved from North London to Basildon, Essex, a ‘New Town’ developed in the wake of World War II, the differences in the environment and the resulting lifestyle differences are stark. While in London people predominantly travel actively, with walking or cycling making up at least some part of the journey, Basildon’s housing estates, retail parks, industrial estates and leisure parks mandate driving to work, driving to shop and driving to play. It is clear, here, the potential for wider societal change to relieve pressure on the NHS from both ends - through prevention of illness on the one hand, and with improved social care taking people out of hospitals and avoiding readmission. Improving towns and cities to encourage healthy living is one potential avenue for public health improvement.
Webber et al. highlight the promise of NHS England’s Healthy New Towns project and call on the government to make health promotion a ubiquitous priority across government departments . The government may be slowly grasping the potential of indirect health promotion; however, private and voluntary sector organisations have the potential to lead the way in this essential revolution. Healthy employees take less sick leave, are more productive when they are at work and make for a happier work environment . This demonstrates that there should be adequate motivation for employers to work to improve the wellbeing of their staff. Tech companies are leading the way with work-life balance and an enjoyable work environment. Simple measures, such as having high quality shower and change facilities, go a long way to encourage an active commute. Running or cycling to work is good for physical health, mental health and is cheaper and less stressful than other modes of transport.
With the growing potential of health apps and wearable fitness trackers, employers and/or the government could, in the future, directly incentivise healthy living. Sweatcoin is an app that allows users to earn ‘credits’ for the number of steps you do each day. These credits can then be redeemed for rewards and gifts. With further development and research into the efficacy of direct incentivisation for healthy living, it is not hard to imagine a future in which the NHS or employers rewarded people for exercise through fitness tracking apps and hardware.
Preventing illness stretches well-beyond the remit of doctors. Pushing health onto agendas beyond the Department of Health and Social Care, throughout government and the private sector, is key to ensuring the NHS can flourish for another 70 years and beyond.
 Webber Laura, Chalkidou Kalipso, Morrow Susie, Ferguson Brian, McPherson Klim. What are the best societal investments for improving people’s health? BMJ, 2018; 362 :k3377
 Marsden, D., Moriconi, S. The value of rude health. London School of Economics, 2008.
Competing interests: No competing interests