With NHS funding a hot topic on the political agenda, the focus on individual conditions, such as cancer and dementia, remains strong. As the Liberal Democrats head to Glasgow this weekend, we can confidently expect mental health to be a key focus and recurrent theme both in the hall and across the fringe events.
These condition areas, together with heart disease, stroke and diabetes, have become the usual suspects in terms of political prioritisation in the context of a health service increasingly focused on prevention, early diagnosis and resulting premature mortality. With this in mind, why does one of the leading causes of premature mortality in UK continue to be overlooked?
Respiratory disease kills one in five people in the UK. Lung cancer is the biggest cancer killer in the UK, causing more deaths than breast cancer. The most prevalent type of respiratory disease – chronic obstructive pulmonary disease (COPD) – is the fifth biggest killer in the UK, and the World Health Organisation (WHO) predicts that it will become the third leading cause of death worldwide by 2030. Britain has one of the worst death rates for respiratory disease in Europe
Although some policy documents, such as the NHS Outcomes Framework, have acknowledged the importance of respiratory disease, a recent report by the APPG on Respiratory Health found that “the long-term under-prioritisation of respiratory health means that outcomes improvements are not keeping pace with those in other conditions”. Why? A contributing factor seems to be the link between respiratory disease and smoking. The idea that people with lung conditions have “brought it on themselves” has undoubtedly played a role in stigmatising this collection of conditions.
There are two problems with this rationale. Firstly, a huge proportion of respiratory conditions are work-related, causing 12,000 deaths a year, or unrelated to lifestyle factors. The cause is even unknown for some conditions. Take for instance idiopathic pulmonary fibrosis (IPF), global awareness of which is being raised this week via World IPF week. The cause of this life-limiting condition is unknown, and with no cure for the 5,000 people are diagnosed with IPF every year, just half will live for more than three years after their diagnosis.
Secondly, there is an ever increasing body of evidence on the links between lifestyle choices and an array of health conditions; in the same way that we do not point the finger at an individual who has had a stroke or has heart disease or cancer, so we must not play the blame game where respiratory conditions are concerned. To do so fundamentally undermines founding principles of the NHS: that it meets the needs of everyone based on clinical need.
Additionally, with 15.4 million people in England living with one or more long term conditions and the number of people with three or more long term conditions expected to increase from 1.9 million in 2008 to 2.9 million in 2018, it is not tenable for the NHS to be good at treating problems relating to your heart but poor when it comes to looking after your lungs.
If politicians are serious about reducing premature mortality in the UK, they must make the prevention, early diagnosis and effective management of respiratory disease a key part of their approach. For so long the poor relation, it is now time that respiratory conditions are given parity of esteem with other priority condition areas. Whether this opportunity will be seized in the run up to the election, and by which party, remains to be seen.