This week was Longevity Week in the UK. A series of events sponsored by The Longevity Forum. The theme this year was “Prevention”. It started with the Longevity Forum itself, now in its seventh year. I was grateful to be invited to a fascinating morning of panels and presentations.
The stage was well set by Richard Meddings, chair of the UK National Health Service. His theme was the level of innovation already going on in the NHS. Something that few people realise and seldom features amongst all the bad news. The 780,000 genomic tests last year, the AI used in diagnosis, and the virtual wards. These allow people to be treated at home as if they were in a hospital. As he said,
“The NHS is no longer the NHS of the iron lung”.
At the same time, he laid out the demands on the system. The NHS will have to cope with these whilst switching to a more preventative mode. The 15% population growth. The 28% of the population that are clinically obese. The ageing of the population. The over 65’s are 25% of the population but represent 50% of hospital admissions. They occupy 76% of the beds. Dementia patients now account for 25% of bed occupancy. “We know that hospitals are bad for older patients so how do we prevent admissions?” At the same time bed numbers have dropped from 122,000 in 2010 to 97,000 today. Capital spend has been cut or diverted to day to day running costs.
Other panels in the sessions stressed the productivity issues with the NHS. Their focus was on the incentives and metrics that drive the organization. There is no incentive for Prevention. They claimed that more than half of the money going into the NHS does not show any measurable benefit to the nation’s health. They believed that the answer was “clicks not bricks”. Technological enablement:
“Technology is our Get Out Of Jail Free Card”.Penny Dash, Chair, North West London Integrated Care Board
Juxtaposed with the NHS was M42 the medical supplier to Abu Dhabi. Hasan Jasem Al Nowais, their CEO, described their massive technologically enabled solution. With a smaller population and a “fresh start” they are integrating innovative ideas from around the world. Their focus is on “Prediction, Prevention and Precision Medicine”. They currently have a full genome sequence for 750,000 citizens. That is out of a total population of only 1.4m. They are building AI predictive models to identify high risk patients. He gave the example of a patient identified as having a high risk of colon cancer. He was then advised on diet and lifestyle. They are addressing prevention at the root cause genetic level.
They have AI enabled much of the routine diagnosis of X-Rays and scans of all sorts. All are designed to gain the earliest possible diagnosis so that prevention be given the best chance. Ben Maruthappu is the CEO of Cera, a UK care sector company. He was on the next panel and gave a powerful example of the preventative power of technology and AI. He pointed out that there were 2m home visits per month by care workers in the UK. His organization equips those carers with an App. They can record the details of their visits and the people they are caring for. They apply AI to those records and now have an 83% accuracy in predicting whether someone will fall in the next 7 days. They claim to be cutting hospital admissions by 70% by stepping in early.
Multiple Pathways to Prevention.
In last year’s Longevity Week, an underlying framework emerged. This divided the potential solutions into two: science and behaviour change. The second dimension was the actors involved: the Government and the Commercial Sector. The pattern reemerged when focusing on Prevention this year.
There were multiple examples of behaviour changes that would make a big difference. The UK has one of the lowest rates of sustained breastfeeding of babies. All the data shows that higher rates mean less infant hospital admissions. Obesity has quadrupled in the UK in the last 30 years. Childhood obesity is rising faster still. Physical activity at work or for leisure has declined in that period. The biggest cause however is calories. As Susan Jebb of Oxford and Chair of the Food Standards Agency, put it:
“You cannot outrun a bad diet”.
Some calories may be better than others, but it is the number of calories that are the issue.
According to the obesity panel this is not a genetic or behavioural issue. Lord Bethell, Commissioner on the Health and Prosperity Commission put it nicely.
“Junk food is engineered to be addictive”.
The food creates its own cravings. We have all seen the “Supersize Me” documentaries. At the same time junk food crowds out better food from the shelves in the supermarket. Junk food outlets crowd out the salad bars. Deliveroo only serves to reinforce the addiction.
The morning included organizations tackling health in all parts of the framework. A panel included "exercise for longevity", better gut health and managing hormones businesses. There are growing pockets of health-conscious consumers. They will adopt the “exercise for longevity” model. The will buy "Bio & Me" healthy foods. However as Lord Bethel pointed out
“less money makes it tougher to make good choices”.
More money means more chances to exercise, more time to focus on the gut and hormones. More money tends to come with better education and health awareness. Deprivation and obesity go hand in hand. You cannot just ask people to change their eating habits.
As far as Susan Jebb was concerned there was only one solution.
“It is massively easier to change products than people”.
She said that the only solution is legislation. She is Chair of the Food Standards Authority. Unfortunately, its mandate is food safety not nutrition, that rests with the Department of Health. Legislation or taxation of sugar are powerful levers. She believes the food companies will pivot if regulation happened.
Science can help obesity, and the drugs do work. From a prevention perspective they are however a small part of the solution. According to Lord Bethell, 1 in 8 people in the USA are on the weight loss drugs. Today, in the UK, only 400,000 people are estimated to be users. Of those only 20,000 are getting the drug through the NHS. These national differences illustrate the complexity for policy setters.
There are two problems being debated by UK providers. 50% of people stop using the drugs within the first year. They may not like the side effects or the impact on their enjoyment of food. In any case, people do not stick to their medications generally. Most people can lose 15% of their weight but the drugs are expensive. Unfortunately weight lost with drugs comes back very quickly. Obesity is a chronic recurring condition. Drugs can help and motivate. They must be part of a long-term change in behaviour.
It is clear that an integrated approch is needed for Prevention to work. Behaviour change and science must work together. So to must all parts of the economy.