Population health and condom sense

The Dutch philosopher, Desiderius Erasmus, in the 16th century, popularised the phrase ‘prevention is better than cure’. Today, it has become the adage for so many things in life, but particularly when it comes to public health and health prevention. It is a concept that underpins one of the three ‘left shifts’ set out in the NHS 10 Year Health Plan (from hospital to community; from analogue to digital; from sickness to prevention).

This is not a new idea. For example, the Sure Start scheme was very effective. The use of early intervention, providing help and support to new parents, made such a difference to the wellbeing of families and enabled many children to thrive and enjoy better life chances. Sadly, the scheme was abandoned almost in its entirety after 2010.

Norman Lamb, the former MP and Minister of State for Care and Support has been a long-time advocate of joined-up health care. He championed a greater focus on preventing ill health. He has long campaigned for mental health to be given the same priority, as physical health. Last week, he published an article in the Health Service Journal on what the 10 Year Health Plan might mean for mental health care and services in England.   

His article focuses on many areas of mental health that he feels need reforming. Rightly, he notes that demand for mental health care is growing exponentially, and in particular with young people. Currently services cannot, or do not, meet this growing need. Norman shares his concern, a concern shared by many others, that too many young people are turning to chat-bots and other AI sources for help and advice. The evidence is mounting that many of these online services are potentially harmful. I absolutely agree. As the NHS moves from analogue to more digitally-resourced service provision, we need to find ways of distinguishing what might be truly therapeutic and what isn’t.  

In so doing, not only will it require governmental direction and support, but also greater clinical leadership.  Such leadership must combine the best that primary care can offer, with greater accessibility to specialist consultant-based care. There are early signs that this is happening, but I would argue, it is probably not happening fast enough. However, speed is not always the answer.

Last week, saw the passing of the Tobacco and Vapes Bill. It’s a very clever piece of public health legislation. Essentially, anyone born on or after 1st January 2009 will now never be legally able to buy tobacco products. From 2027, the legal age for the sale of tobacco will rise by one year. Currently the legal is age is 18. Generally, if someone hasn’t started smoking by the age or 20, they are unlikely to ever start. Over time, the number of people who will be able to legally smoke will become smaller and smaller. A good thing!

The law relates to those who sell tobacco products, not to those who choose to consume them. It’s an important distinction, but I do wonder how it might be policed. That said, I foresee similar approaches perhaps being considered over the sale of alcohol and ultra-processed foods, both of which cost the NHS millions of pounds in treatment costs for the conditions both can cause. What I didn’t foresee, however, was the condom crisis.

Apparently, the conflict in the middle east and the shutting of the Strait of Hormuz is pushing the cost of the raw materials used in manufacturing condoms to unacceptable levels. The result is a steep rise in the cost of condoms. The fear is that such a price rise will stop people using them. Now for some, the condom is the ultimate symbol of prevention (think HIV, sexually transmitted diseases and unplanned pregnancies). Indeed, when I read the story, I was reminded of a conference I attended with a couple of colleagues in Evora, Portugal. We sat in the audience listening to a speaker from a university in Liverpool, talking about research she had undertaken into the sexual health of sailors in the Port of Liverpool.  

I’m ashamed to say that my colleagues and I started giggling like school children, as she referred to her participants as seamen and not sailors. In my defence I would point out it was 24 years ago, and I have hopefully somewhat matured since then. Interestingly, I looked up when it was, we presented the paper at that conference. I was intrigued to see that the paper’s title seemed very apposite: The NHS Plan: A health rhetoric and an unhealthy reality? I hope today’s NHS 10 Year Health Plan proves to be neither.