Helen Salisbury: Smartwatches and playing fields

The best way to reduce the cost of healthcare is to stop people being ill. This obvious fact has been stated many times, but the actions needed to bring about this healthier society have yet to materialise. Much is written about the importance of preventive healthcare, but generally by the time you see a doctor the window for prevention is already closing.

Only a small part of what I do as a GP is purely preventive, such as overseeing vaccination programmes. Much more of it is early detection, which includes picking up problems when they’re easier to treat, such as through cancer screening programmes or blood pressure monitoring. However, most of my work is treatment of illness: seeing people with symptoms, making diagnoses, and treating established disease processes.

In cardiovascular health, we classify treatments as primary prevention if patients are at risk; secondary prevention if they’ve already had a stroke or heart attack. But when we see patients who have high cholesterol, hypertension, obesity, a sedentary lifestyle, and a history of smoking, even if they still technically fit the definition for primary prevention, we’ve already missed the opportunity to preserve their health through preventive measures. We can pick up the pieces with medication, but the trajectory of good or ill health is, for all of us, set early in life.

Our secretary of state for health and social care, Wes Streeting, is pinning his hopes on new technology to keep us healthy. But, while it can provide information, that alone won’t change outcomes.1 The ready availability of bathroom scales hasn’t averted the obesity crisis, and smartwatches that tell us how many steps we’ve taken won’t provide the infusion of willpower needed to make the nation rise from its collective couch. There’s also a risk that high tech wearables will detect minor and asymptomatic abnormalities—generating investigations, diagnoses, and treatments of only marginal benefit to the patient and at considerable cost to the NHS.

Action and early intervention around the social determinants of health—poverty, diet, housing, and education—would constitute true primary prevention: this would be vastly more powerful than anything medicine can do, and it would reduce costs and workload in the NHS.2 Some interventions in early life, such as greater availability of healthy food or access to green spaces to play, wouldn’t immediately show up as savings in health spending, but as a generation of children grew up to have lower levels of diabetes, arthritis, and other obesity related morbidity in middle age, the NHS would be less pressured. In the past such benefits have been realised surprisingly quickly, as shown by the positive effect of access to Sure Start centres on rates of hospital admission in children and teenagers.3

We need a shift in mindset away from tech solutions and individual choices, towards government led changes to the obesogenic environment. It would help if we were no longer constantly bombarded with inducements to fill ourselves with low cost, calorie dense, nutritionally poor foods. Attention to inequalities and a focus on the social determinants of health are likely to achieve more for a greater number of people—and at a lower cost—than any of the high tech solutions currently being considered.