Photo: Frances M. Roberts

The foremost public health emergency in our mind at the moment is, of course, Covid-19. But we must be careful, not to forget more familiar enemies, such as hypertension, cancer and heart disease, which are all closely associated with Covid-19 severity and mortality.

As we saw in the 2013-14 Ebola outbreak in West Africa, when the health system is preoccupied with one disease, others can run rampant. The latest Office for National Statistics (ONS) death statistics show an extraordinary rise in deaths from causes other than Covid-19, leaving doctors around the world nervous and bemused.

To offset the potentially devastating indirect impacts of Covid-19 and future pandemics, we need healthier populations. In this pursuit, we can either target those at highest-risk, or introduce measures that affect the masses. It is easy to imagine that highly targeted public health interventions are most effective, but this is not always the case. Note that with Covid-19, the global position quickly escalated from tracing and testing high-risk individuals, to enforcing lockdown measures affecting everyone.

A population centered approach

Covid-19 aside, as long ago as 1985 in an article “Sick Individuals and Sick Populations”, epidemiologist Geoffrey Rose questioned the traditional presumption that interventions should only target high-risk groups.

Rose observed a “painful truth” that even for those deemed to be low risk, the commonest cause of death was by far coronary heart disease. Everyone, he concluded, “is a high-risk individual for this uniquely mass disease.” Rose opined that even a small reduction in risk at a population level would therefore provide a greater benefit than merely targeting those at highest risk.

This is the winning essay of this year’s Bennett-Prospect Prize for Public Policy. To find out more about the prize, click here

Since Rose’s article, extensive evidence has accrued in his support. From obesity to smoking, interventions affecting whole populations are known to be more effective than those targeting high-risk groups alone. Such measures typically involve legislation to inculcate healthy behaviours at a societal level. By changing society from above, they do not depend on a sustained individual response. These measures therefore have the potential to be the most effective, equitable, and affordable, of all interventions.

Health Taxes

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