The writing has been on the wall for years. Decades of worsening socio-economic inequality, unfettered access to unhealthy dietary and exercise choices, and increasing use of alcohol, at a time when we are actually living longer, has lead to unprecedented demand on health services. We might live longer but we live with multiple medical problems, each with their own complexity, and each demanding more, already limited, NHS resources; something has to give.

Imagine a scenario where there is a high cliff edge where people like to walk. As it becomes more popular inevitably more people stray closer to the edge and eventually some fall off. Faced with this new health crisis the natural reaction from health service decision makers is to improve access to emergency care, to provide more ambulances at the foot of the cliff. A less glamorous approach, and a much less expensive option however would be to provide a more robust barrier at the top; to prevent people falling in the first place; health prevention. 

The problem we face as a nation now is that we have, for decades, prioritised treating disease over preventing it in the first place. Our NHS is a treatment service, not a prevention. And though the results of preventative measures take a while to develop, they are more productive, more economical, and more equitable. In these days of limited resources we would, in short, get a bigger bang for our buck. 

As a clinician I know that my patients have choices, that we have a personal responsibility to ourselves, our children and our society, to make better, healthier choices; but as a doctor interested in the health of the nation as a whole I know we also deserve support from government. Limiting access to unhealthy food and marketing policies, restricting advertising to children, making our communities safer for children to play outdoors, making “active travel”, walking and using public transport, easier, cheaper, and more convenient. We need to make healthy choices the easier choices. This will only occur when government, local and national, steps up, takes responsibility and makes it happen. As individuals we can only achieve so much; we need to work together to produce a healthier, safer, more equitable society. If we are to respond appropriately to the PHE report warnings about our future, then there is no other realistic choice.