While some risks for disease like our genetic make-up cannot be modified, many risks are amenable to reduction. The major modifiable risk factors for the modern plagues are outlined: our body mass index and obesity; our levels of physical activity; and degrees of social isolation. While infections spread through a population owing to the transmission of a physical disease agent, research shows that modifiable risk factors like obesity spread via social networks. These modifiable risk factors all arise from modern ways of life. This term is preferred to ‘lifestyle’ which implies that way of life is a matter of individual choice. This chapter looks at the definition of obesity, its prevalence and its transmission through social networks. It considers historical change in the prevalence of physical activity and recommendations on optimal levels of such activity, the rise of social isolation, and the risks that arise from the current modern way of life.
Systems Prevention means transforming all of public policy and the relationships between its components. The authors call this reform the construction of a national Health Society. They identify the three main pillars of the changes required as institutional change, community change and technological change. Change affecting these three pillars needs to be concurrent. Health (as needs satisfaction) should be at the top of the agenda of all branches of national and local government. The critical role of central government is in coordination and this finds institutional expression in health becoming the responsibility of a Deputy Prime Minister and in the modern plagues all being identified as risks on the National Risk Register. The Health Society has significance for every department of government and some of these are explored.
Saving sick Britain lays down a challenge to every citizen, to British institutions, policymakers and scientists. Epidemics in common diseases and conditions like diabetes and depression pose systemic risks to society, which are as serious as those from Covid-19. These modern plagues are the challenge of our times. The authors argue that these epidemics require us to think afresh about the prevention of disease. They first examine the basics of contemporary political philosophy and modern biology to redefine what ‘health’ really means. They then outline a practical way to focus society relentlessly on maintaining the health of all its citizens. This plan is not just another reform of the National Health Service. It calls for far more than that. The authors aim to construct a national ‘Health Society’ and this requires across-the-board reform of the entirety of public policy. Every department of government – national and local – needs to change. Every workplace, every employer, every community organisation and every citizen has a role to play. Because the authors have a background in basic biology, they come at the problem of prevention from a new direction, unburdened by the traditions of the medical profession or by ideological dogma. Two millennia ago, Hippocrates said prevention was better than cure, and Cicero said population health was the supreme law. They were right. But they could do precious little about it. Yuille and Ollier show how today we can turn their insights into reality.
Diagnosis of one of the modern plagues is simply the beginning of the accumulation of disabilities at the end of healthspan. Other long-term conditions – including more than one modern plague - tend to arise after the diagnosis of the first one. Individuals must endure successively increasing numbers of long-term conditions. Diabetes is associated with increased risk of heart disease and damage to nerves, kidneys, eyes and feet. Conversely, smoking, alcohol and pollution are among the risk factors for the modern plagues.
By considering health as the status of an individual when their needs are optimally satisfied, it becomes apparent that health cannot be the responsibility of a specialised arm of government. It needs to be the driver of public policy as a whole. This general principle finds its roots in Cicero and has been endorsed by political philosophers of the Enlightenment. The limited successes are discussed of an untheorized Systems Prevention in some modern institutions (Public Health England, the Health and safety Executive and the NHS Health Check). Research projects that might be the basis for Systems Prevention are described. The authors describe their own research experience that underpins the plea of this book to deliver Systems Prevention consciously. This experience includes work on developing the infrastructure required for health improvement.
There are no significant technological obstacles to achieving the Health Society. However, there is work to be done in constructing national infrastructure: a secure, national data and sample management system is necessary. This will permit discovery and use of new biomarkers for estimating reduction in risk and will enable continual estimation of changes in health risks in the population.
This chapter illustrates how observational epidemiology has recognised the breadth of sources of risks to health. This breadth is captured in the word ‘exposome’: the sum total of exposures to sources of risk. The development of concepts is described as to how living systems maintain their equilibrium and how this equilibrium may be disrupted. This equilibrium – or homeostasis – is illustrated by considering the role of glucose. Research in understanding mechanisms for homeostasis is described but caution is expressed on the limited value of genetics in addressing disruption of equilibrium.
Many of the words that this book uses with precise definitions are in common usage with definitions that are less precise. Common usages and their limitations are illustrated and discussed in this chapter in order to prepare the reader for more precise definitions.
This chapter summarises the book’s messages and proposals for change. The Health Society relies on a consensus that ‘your health is my health’. Achieving that consensus requires the countering of objections. These are considered and their weaknesses exposed. Synergy is noted between health as needs-satisfaction and action against global heating.
As with the plagues of the past, the modern plagues increase the risk of breakdown of trust and social order, and perpetuate health inequalities. The modern plagues confer very large financial costs on society and some of the estimates of these costs are described for each of the common long-term conditions, singly and collectively. The societal costs work in both directions: a dysfunctional community (one with social fragmentation) increases the prevalence of the modern plagues and those plagues, in turn, tend to make communities dysfunctional.