Foreword by Professor Kevin Fenton
I am often asked whether the NHS Health Check programme will worsen health inequalities. This is a concern of all prevention programmes. And while we will be evaluating the data closely to ensure this is not the case for this programme, I wanted to share my thoughts this month of how good programme management, robust monitoring and evaluation, and local innovation may provide an opportunity for us to view the NHS Health Check programme as an additional tool in our efforts to tackle health inequalities.
The reality is that we currently have a high burden and marked inequalities in a number of chronic diseases, many of which are longstanding and pervasive. For example PHE's Longer Lives website highlights variations across the country in lung disease, heart disease and stroke. Dealing with these inequalities will require attention to individual, clinical, community and societal-level interventions which are combined, implemented and scaled for greatest impact. No single intervention is likely to suffice.
As a population-based risk awareness, risk assessment, and risk and disease management programme, NHS Health Check has the potential to ensure that we are engaging members of the community earlier, promoting opportunities for healthy living and early intervention. However, as with the implementation of all prevention programmes, there is always a risk that the “worried well” will be the first to take up the service, while those who are hard to reach or hard to engage with won't do so, with the effect of worsening health inequalities. However this risk should not mean that we do not deliver prevention programmes, but rather that we take this risk into account in the ways we develop, implement and monitor our programmes, so that we address inequalities head on.
Although all persons aged 40-74 years should be offered an NHS Health Check every 5 years, the programme also provides Local Authorities with the flexibility to focus and intensify this offer in geographic areas or with disadvantaged or high-risk individuals and communities. In this way, the mandate to provide NHS Health Checks to the population is met, while leveraging the programme to address health inequalities.
There are now promising examples of where this approach is being used to great effect. Local Authorities have intensified their offer by using outreach workers to directly engage with vulnerable communities; locating services in deprived areas; working with a broader range of community providers e.g. pharmacies, voluntary and community organisations that have a presence among more disadvantaged communities; ensuring that NHS Health Check materials are translated and culturally relevant; and examining innovative delivery methods such as health buses. In addition to these enhancements, it will be important for implementers to be reviewing their programme data to examine coverage, uptake and outcomes results from these intensification efforts. Using programme data to monitor, evaluate and refocus the NHS Health Check efforts is an essential component of good programme management.
Finally, Local Authorities, with their detailed knowledge of and access to their local population, can engage their local communities, including the most disadvantaged, to raise awareness, and tailor the NHS Health Check programme to be more locally relevant, appropriate and acceptable. The NHS Health Check programme will not be the only strategy to address inequalities.
In our effort to prevent chronic diseases and avoidable mortality, it is clear that multiple synergistic interventions that are sustained over time are needed. We all have a responsibility to ensure that we use the flexibility and innovation that the programme provides not only to offer the checks to the eligible population, but to intensify our efforts with those in greatest need while evaluating programme data for continued improvement.