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Tuesday, April 13, 2004

Poor Health of Britain's Poor

Is more intervention to tackle health problems amongst the poorest in our community a necessary step, or one step closer to the ‘nanny state’? Roger Harrabin reports.

One of Britain’s leading public health doctors has warned that the Government may need to intervene much more intensively in the health of the poor if it wants to stop NHS costs spiralling out of control.

Poverty-related problems like heart disease, diabetes, smoking and obesity are costing taxpayers up to £30 billion a year according to the recent Wanless report to the Treasury. That’s the equivalent of a tax cut of 9p in the pound.

The inability of many poor people to take care of themselves is becoming a major worry to the Treasury, with concerns every pound spent on the NHS produces a disturbingly low return.

But Dr Harry Burns, head of public health in Glasgow, told us that many poor people’s lives were so out of control that they couldn’t take doctors’ advice to lead healthier lives.

He said there was evidence from research in the USA that people suffering from multiple stress needed much more intensive intervention than ministers has recognised so far.

He admitted that intervention could bring an accusation of nannying individuals, but said some individuals needed nannying so they could learn to stand on their own feet.

Brown University in America conducted a trial of methods to prevent overweight people from getting diabetes. Simply advising them to lose weight and giving them an anti-diabetes drug didn’t help much. What really did help was an intensive programme of lifestyle coaching.

Each patient was set individual targets to exercise for half an hour a day and counselled about any obstacles to their progress. The results were stunning – significant weight loss and success in staving off diabetes.

The results present a serious challenge to health providers around the developed world.

In the UK there have been recent NHS moves towards improving preventive health, but politicians and the media tend to focus on the need to get sick people into hospital rather than the need to stop people getting sick in the first place.

The American research suggests that a new form of health support, not necessarily run by doctors, may be needed. These issues will be considered by the Government in a white paper in the summer.

The problem is particularly acute amongst the poorest in society. It is well documented that the poor suffer more chronic stress than the rich.

At Rockefeller University in New York, neuro-biologist Professor Bruce has studied the effects of long-term stress on the functions of the brain. He concludes that a stress hormone, cortisol, may actually be damaging the brains of the poor and hindering them from choosing healthy lives.

Listen to Roger's report from New York, plus our interview with Dr Harry Burns, Director of Public Health at the Greater Glasgow NHS Board (13/04/04).

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