HEALTH promotion should not be broad cast to the nation. It should instead be narrow cast to the individual. Just as when one is ill one expects individual attention from a trusted health professional, one should also expect that health promotion and disease prevention advice should come on a one to one basis.
Health promotion and the prevention of disease are attractive concepts. Attractive to the individual, as he or she sees the opportunity to lead a longer, healthier life. Attractive to government because, in theory, less revenue needs to be found for increasingly expensive hospital procedures.
But does the concept actually work? Press reports in the UK suggest that it does not. Despite a British government campaign to persuade people to lose weight, quit smoking and drink less, levels of obesity are actually higher than when the £12 million drive was started four years ago, while more women are drinking and more young people are smoking.
Perhaps this is because such advice just washes over people and is so all pervasive that people just don't see it any more.
There is also the problem that when health promotion is sprayed at a community, some inappropriate targets can be hit, while others which should be hit are missed.
Take the example of "safe limits" of alcohol consumption. The current medical consensus is that "moderate drinking" is good for you although doctors keep changing their minds on what the definition of moderation is. While such limits might be appropriate for some, they are certainly not appropriate for a person with, for instance, an alcoholic parent, or someone with an addictive personality who is at risk of alcoholism. Such people are inadvertently being given permission to indulge in a habit which may very well be dangerous to them. If these vulnerable individuals were to get one to one advice from their GPs, they might well be told that the usual limits are too high for them.
Another hot topic is the alleged link between "healthy eating" and disease, particularly heart disease and cancer. The main causes of heart attacks are probably smoking and family history. Smoking is the one health warning that I would agree should be broadcast to the nation. But what about warnings about high fat diets?
There is no point in a smoker going on a low fat diet. His or her risk from smoking far outweighs the risk from cholesterol. And there is probably little point in people over 60 having their cholesterol levels measured, because if it has been high until that age, the damage is already done. US research shows damage to the coronary arteries as early as eight or nine years of age.
If one has normal cholesterol, there is simply no point in cutting out dairy products, red meat, eggs and so on. The people who should be concerned about their cholesterol levels are those with a family history of cardiovascular disease.
Our most senior cardiologists are currently engaged in a public debate on the dietary influences on heart disease. Where there is such disagreement, it would make sense not to change one's way of life until something, clear emerges from the melee.
I said earlier that in moderation alcohol has a protective effect on the heart. It has. However, if taken in the form of beer, and to excess, there is evidence that it can cause cancer of the bowel.
Fibre is now thought to be the great white hope in preventing this and other bowel disorders, but what kind of fibre? Evidence is beginning to emerge that it is only the fibre found in vegetables and fruits that is of use, and that perhaps fibre from various grains such as wheat is not as good. Thirty years ago, your doctor would be prescribed a low fibre diet for many bowel conditions, and now the profession has reversed this.
A senior colleague recently wrote. "Tell your patients to eat what they like. You'll be right at least half of the time."
There is a danger that the individual, at whom all this good advice is aimed, will see that the experts do not agree on parts of it. This may in turn devalue all of it for that individual, as he thinks a plague on all your houses".
THERE is also a danger that people will become antagonistic to the very notion of health advice, and this antagonism has taken roots in some sections of the tabloid press in the UK and the US, where the terms nanny state and health police have been coined to describe those who would lead our lives for us.
There is also the opposite danger, that some people will change their diets with every new health fad in an attempt to keep one step ahead of all possible diseases, leading totally miserable lives in the process.
But perhaps the ultimate argument for health promotion advertising campaigns would be that people were getting healthier. In fact, the opposite seems to be the case. It is surely ironic that at a time when people have never been so well educated about health matters, GPs' surgeries are busier than ever, accident and emergency departments can hardly cope and waiting lists grow longer.
There is a way to encourage healthier lifestyles and to prevent disease but unfortunately we aren't doing it yet. This way would be to enable GPs to spend their time giving appropriate individually tailored advice to their patients. Unfortunately, the present GMS contract encourages treating illness rather than preventing it.
In the UK, GPs are paid to do health promotion clinics which target patients who could benefit from specific lifestyle changes. This is the way we need to go if government is serious about improving the health of the population. It would be more beneficial to the individual and ultimately more cost effective for government.