Editor—I was struck by the different businesses included in the broad swipe against prevention and health promotion in Heath's article—national screening programmes, the pharmaceutical industry, health food stores, general practice, and NHS health promotion.1
Some of the referenced targets are fair game—for example, hormone replacement therapy or prescribing statins. But the notion that the United Kingdom invests huge amounts in “the vast bureaucracy of health promotion” was laughable.
The UK has some 2000 health promotion specialists, out of a total workforce of 1.3 million. Fewer than two of every 1000 NHS staff are devoted to health promotion and leading out on the national agenda, “Choosing Health,” alongside colleagues in public health. Evidence for the effectiveness of health promotion is available but not mentioned—for example, reviews by the Health Development Agency (now the National Institute for Health and Clinical Excellence (NICE), www.publichealth.nice.org.uk) and the International Union for Health Promotion and Education (www.iuhpe.org). Clear examples include the reductions in road crashes and adult smoking rates.
Competing interests: None declared.
References
- 1.Heath I. Who needs health care—the well or the sick? BMJ 2005;330: 954-6. (23 April.) [DOI] [PMC free article] [PubMed] [Google Scholar]