Foreword by Dr Matt Kearney, National clinical director for Cardiovascular Disease Prevention
A recently published review of the NHS Health Check reminds us of the strong public health rationale for the programme and reviews the evidence that has emerged from the two published national evaluations (Chang at al and Robson et al).
The aim of the NHS Health Check is to improve health and wellbeing of adults aged 40–74 through earlier detection and management of individual risk factors for vascular disease and other conditions associated with them. It is estimated that around two thirds of premature deaths can be avoided through improved prevention, detection and management of these behavioural and physiological risk factors. The 2013 Global Burden of Disease Study identified and ranked the top 20 risk factors which contribute to premature death and disability. In England, diet is the leading cause, followed by tobacco, high body mass index, high blood pressure, alcohol and drug use, raised blood sugar, high cholesterol and abnormal kidney function. These factors are linked with a range of health conditions, but the largest impact is through cardiovascular disease.
It is important to acknowledge that population-level interventions are the most important in tackling the structural causes of preventable ill health. But support for risk reduction at an individual level is also crucial, and a core function of the NHS. The NHS Health Check offers a systematic approach to supporting this kind of preventative health care by specifically targeting the leading behavioural and physiological risk factors identified in the Global Burden of Disease Study.
Each of the interventions delivered by the NHS Health Check is based on robust NICE evidence of effectiveness. Where we lack evidence is on whether a national programme of this sort is an effective means of delivering these interventions and improving outcomes for the population. The first two national evaluations of the NHS Health Check programme have recently been published. Between them these studies looked at 300,000 health checks. Key findings are that the programme is helping tackle health inequalities, with no difference in uptake between poor and affluent communities; that attendees are more likely to have lifestyle risk factors identified and to be referred for behaviour change support; and that attendees are more likely to have high risk conditions (such as undiagnosed hypertension or diabetes) detected.
Both studies, however, highlight the low uptake rates in the early years up to 2013, and quite rightly identify uptake as a key determinant of the success of the programme. From routinely collected data we know that uptake has improved considerably since Local Authorities took over commissioning of the programme in 2013: almost 100% the eligible population are now receiving their invitations, and just under 50% are taking up the offer. This is encouraging but there is still scope for improvement if the NHS Health Check is to deliver on its promise.