Category: Analysis

Prevention is the policy we keep ignoring…

Modern healthcare systems excel in intervening once people are already unwell – clinicians diagnose, treat, and manage complications whilst we absorb the rise in costs. What these systems are far less structured to do, is prevent the disease from occurring in the first place. An estimated 40% of ill health in the UK is preventable, yet the health system is overwhelmingly focused on treating diseases rather than preventing them.

This imbalance is not limited to the clinic, but also poses major moral and socioeconomic risks. Whilst the NHS is continuously overburdened with budgets and resources being unrealistically overstretched, preventable diseases continue to drive avoidable suffering, widening health inequalities and pushing public spending. Yet, despite prevention-focused initiatives such as the NHS Prevention Programme, measures remain significantly under-prioritised in policy and funding frameworks. If prevention is evidently beneficial, why is it not at the core of healthcare system policies and frameworks?

What do we mean by prevention?

Prevention is multi-tiered:

• Primary prevention – stopping the disease before it develops, for example vaccination, obesity prevention and smoking cessation.
• Secondary prevention – detecting the disease early, when outcomes are better and costs are manageable, for example early screening and diagnosis.
• Tertiary diagnosis – reducing complications when the disease is established, for example glucose monitoring and physiotherapy. This is synonymous with disease intervention.

In the UK, a substantial budget is spent on tertiary prevention where the disease is most advanced, complicated and costs are highest. By contrast, primary prevention receives a lower proportion of healthcare spending despite its long – term advantages, with only 6% of total healthcare expenditure focused on primary prevention initiatives.

The true cost of preventable disease in the UK – real world examples

Many of the major health conditions placing the greatest strain on the UK’s national healthcare service are not inevitable – they are highly preventable through modifiable risk factors, social structures and policy changes. They’ve also been a part of the prevention conversation for many years. Below are 3 key examples:

Cardiovascular disease (CVD)

CVD remains the leading cause of death and disability in the UK; it is also one of the most preventable through limiting risk factors. Key drivers include smoking, high blood pressure, poor diet and lack of physical activity. A substantial proportion of CVD cases could be delayed or prevented entirely through population-level prevention measures such as tobacco tax, active commuting initiatives and restricting access to unhealthy foods. Yet, treatment (intervention) of CVD takes priority and dominates spending through emergency hospital admissions, long-term medication prescriptions and invasive surgical procedures. Currently, CVD intervention costs the UK health service over £18 million.

CVD burden is not evenly distributed, with rates of CVD being higher in more deprived communities, thus further contributing to health inequalities. As such, prevention is not the sole responsibility of the individual but a combined effort to change food and lifestyle systems, health education and access to support.

Cancer

Cancer care is one of the fasted growing areas of NHS expenditure. Whilst not all cancers are preventable, over one third are linked to modifiable risk factors including smoking (lung cancer), infection (HPV, cervical cancer), alcohol consumption (liver cancer) and obesity (bowel cancer).

Here, primary and secondary prevention with early screening and detection not only improve survival rates but also drastically reduce treatment complexity, quality of life and cost (both direct and indirect). Late stage cancer care is physiologically, emotionally, logistically and financially taxing and often less effective than early stage disease. At late stage, productivity loss, absenteeism and out-of-pocket expenses compound adding to the pressure felt by a cancer diagnosis. Important to note here, is that late stage diagnosis and a lower standard of care are most common in deprived populations, widening the inequality gap (another growing health issue we will discuss in the future).

So why has prevention remained a low priority?

We know that prevention is effective, so why has it remained under-prioritised and under-funded? Well, this is due to several barriers not limited to:

• Measurement and data collection challenges – it is easier to count the number of treatments delivered than it is to model the number of diseases avoided and attributing that to specific prevention factors. Although QALYs and DALYs model avoided disease burden, prevention is measured by events that don’t occur and aren’t accurately recorded, such as admissions avoided or complications prevented.
• Budget pressure – as costs are constantly fluctuating, prevention budgets are usually amongst the first to be reduced often due to delayed returns. In contrast, spending on treatments provides immediate, visible outputs so is prioritised.
• Political priorities – prevention-associated benefits are often beyond the scope of electoral campaigns, with focus and funding redirected to alternative initiatives.

From a political and financial perspective, prevention sits in an uncomfortable policy space at the intersection of health, education, housing, transport and employment. As a result, prevention is frequently discussed but rarely implemented.

The socioeconomic case for shifting focus

Healthcare economic analyses increasingly reinforce what evidence has long shown: prevention delivers strong returns that extend beyond healthcare budgets into productivity, social care and consistent workforce participation.

The more people we have in good health, the more they can contribute to our society and economy.

If government policies redirected funding to prevention, it could unlock substantial long-term savings and increase returns; every £1 invested in prevention can generate multiple pounds in return, with wider social and economic value. Lowering preventable mortality even marginally, would save thousand of lives annually whilst also relieving pressure from public health services – a critical consideration given the current climate of the NHS.

Shifting focus does not require drastic policy changes; it only requires consistent prioritisation. Key changes could include:

• Scaling up intervention measures that have proven effectiveness e.g. smoking cessation through tobacco tax , and exercise through community-wide initiatives.
• Ring-fenced funding for evidence-based programmes and studies e.g. provide councils with budgets to maintain park runs to promote social exercise regimes. This also supports mental health and the loneliness epidemic.
• Targeting investments towards communities with the highest preventable disease burden to close the inequality gap, as seen with CVD.
• Strengthening data collection infrastructure to link prevention, outcomes and cost to help guide future investment strategies.

Conclusion: Prevention can no longer be an afterthought

The lack of focus on prevention reflects a system failure; one that is currently optimised for illness rather than for health.

Health experts understand disease – the evidence is robust and the economic case is unavoidable. What is missing is not knowledge, it is commitment. Every year that prevention remains under-prioritised, the system pays more for late-stage disease interventions applying pressure to health services, whilst individuals pay with avoidable disease and reduced quality of life. Combined, these factors are generating a system set up to fail.

Without strong leadership and advocates for change, how long can we continue to prioritise intervention over prevention?