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Cost of living

November 5 marked the anniversary of what was almost a very explosive night 400 years ago. Over in the US – just pipping us to the post by a day – November 4 proved explosive this year for somewhat different reasons.

The mood around the world following the election of America’s 44th president has been generally buoyant. The message has been one of change. After a tumultuous year, one can only hope that this will not bring more upheaval to an already fragile global landscape. What remains to be seen is whether all the rhetoric of the campaign can be translated into action.

The US president-elect wants to expand the reach of healthcare so as many people as possible are covered. In the UK, November 5 proved to be memorable in its own right with the news that the National Institute of Health and Clinical Excellence will give more weight to the value of the last months of a person’s life when evaluating the cost-effective-ness of new treatments.

The top-ups debate is understandably an emotive issue which throws up all sorts of questions reaching far beyond the rights and wrongs of such a decision. The most salient of these surrounds the future of healthcare. By this, I do not refer to the NHS alone but healthcare generally.

We are debating the end of a person’s life but what about the life that comes before it? Should we not be investing in that, too, in the form of preventative care? This is not to say that one stage of a human life is more valuable than any other but rather that one stage should not be focused on at the expense of another, not least because they could be inextricably linked.

The Oxford Health Alliance’s 3-4-50 model identified three key behaviours, smoking, no exercise and poor diet, which lead to four critical illnesses, cancer, diabetes, lung disease and heart disease. These four critical illnesses lead to 50 per cent of deaths worldwide.

The reason this seems a fairly simplistic deduction is because it is. Actually, most of us could probably reach a similar conclusion just from reading a newspaper or watching the news. If you smoke and do not exercise or eat well, you are putting yourself at risk of suffering from four possibly fatal diseases.

Yet smoking, not exercising and eating a poor diet are essentially nothing more than lifestyle factors which could be changed. It is not an easy task but they could be changed with time and the right amount of investment. The unintended consequences of Nice’s decision may be problematic, therefore, as there is a risk that we might neglect these valuable investments in prevention as a result.

A recent study based on research from the University of Cambridge and the Medical Research Council found that healthy living could contribute up to 14 years to a person’s life expectancy. There is no question that we should place as much value on those extra good years as we do on the last months of life but will we?

With 2009 almost upon us, it is not just a potential new chapter for healthcare in the US but it could potentially be equally interesting for the healthcare industry in the UK. The debate around the future of healthcare here is undoubtedly one that will continue to generate a range of responses from all quarters, from interest to concern, optimism to enthusiasm. It is not just in the New World that the mantra applies – we all need change we can believe in.

Shaun Matisonn is chief executive of PruHealth

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