Devi Sridhar is right to welcome free cholesterol testing on the NHS in England and blood pressure checks in pharmacies. Such measures can help identify health risks earlier. However, I would take issue with her suggestion that a “health MOT” is “precisely what prevention is all about” (Free cholesterol tests on the NHS are great – but here’s the five-point health MOT I’d really like to see, 2 September).
Sridhar’s proposed five-point health MOT is undoubtedly valuable, but it is better understood as identifying risk rather than preventing disease. Prevention is what comes next: enabling people to make changes that improve health and reduce that risk. Public health has long distinguished between upstream factors, such as poverty, housing, employment, access to affordable healthy food and safe green spaces, and downstream interventions focused on individuals. Screening and health checks sit much closer to the downstream end of that spectrum.
Interventions aimed at changing behaviour emphasise individual responsibility and often assume that everyone has similar economic, social and psychological resources to adopt healthier lifestyles. Yet those living on low incomes, in insecure work or facing linguistic and cultural barriers often have far less capacity to act on health advice. Such approaches can also reinforce stigma by implying that poor health results primarily from individual choices rather than the circumstances in which people live, while diverting attention from the drivers of health inequalities.
In England, people living in the most disadvantaged communities can expect about 19 fewer years of healthy life than those in the least disadvantaged communities. Free testing is welcome, but a genuinely upstream approach would focus not only on identifying risk, but also on tackling the social and economic conditions that make healthy choices possible in the first place.
Dr Louise Lawson
Lecturer in social policy, University of Glasgow
Prof Devi Sridhar is right to emphasise prevention and the importance of identifying cardiovascular risk early. However, screening is only the first step. As a GP in London, I worry that suggesting annual “health MOTs” risks creating expectations that the NHS currently lacks the capacity to meet. Without substantial investment in general practice and community services, what happens after we identify millions more people with pre-diabetes, obesity, mildly raised cholesterol or borderline hypertension?
These patients will understandably seek advice, support and follow-up from their GP. Yet many of these conditions are driven less by a lack of diagnosis than by wider societal factors such as diet, inactivity, housing and poverty. They are not problems that can simply be solved with a prescription, or advice.
Articles advocating routine health checks without this context may also encourage patients to request annual MOTs from their GP when these are not clinically indicated or commissioned. At a time when primary care is already under intense pressure, increasing demand without increasing capacity risks diverting resources from those with established illness and greatest need. Prevention matters, but calls for screening programmes must be matched by realistic plans for what follows.
Dr James Hibberd
Barnet, London
I always appreciate Devi Sridhar’s articles for their straightforward and sensible approach to health. However, could I humbly suggest that she reconsiders the inclusion of a press-ups test? For far too many of us, particularly those with the musculature of an anaemic grasshopper, nightmares of the school gymnasium spring to mind, with those familiar and ignominious collapses on to a sweat-speckled floor. Never to be forgotten.
Bob Forster
Shipton-under-Wychwood, Oxfordshire
I agree with Devi Sridhar that annual screening tests offer the prospect of improving the health of the nation, starting with NHS cholesterol testing for 40- to 84-year-olds. Alas, I’ve just had my 85th birthday, so I’m presumably fit only for the knacker’s yard.
Dr Giles Youngs
Retired consultant physician, Drinkstone, Suffolk
