The NHS 10 Year Plan sets out three big ambitions: to use more digital services, to move care out of hospitals and into the community, and to shift from treating illness to preventing it.
That third aim – prevention – is already being tackled through programmes focused on conditions such as diabetes and heart disease, and risks like strokes or falls. Research is ongoing into what contributes to these conditions, and early detection and screening services are being set up, such as cholesterol and blood pressure monitoring clinics. These, in turn, can lead to the prescription of medication or changes in behaviour – perhaps weight loss or stop smoking programmes. Some of this work has had real success. Recent cardiovascular programmes have reduced deaths and harms for hundreds of residents across Dorset.
But the bigger question is whether this condition-focused approach can deliver the cultural shift needed for people to live healthier lives?
Or is it limited because it focuses on those already unwell?
Why does some change stick?
Across health and local government, people are beginning to ask whether we need to do things differently. Public services tend to respond to new challenges using the same structures and processes they already have. But improving health on a wider scale may require a different starting point – one that looks beyond services and systems.The World Health Organisation’s list of ‘wider determinants of health’ includes employment, housing and education. These are things we now know affect our health, but which are not directly related to healthcare. How people live, what shapes their choices and why change is so difficult – even when we know what is good for us – are all factors we need to hold in mind. But they are not the only influences on our ability to change.In reality, change is rarely planned. It often follows a crisis – illness, loss or upheaval – or a shift in circumstances, such as becoming a carer or losing a job. At other times, it is triggered by something smaller: catching sight of yourself in a mirror, or seeing ‘influencers’ on social media or television. Sometimes it leads to trying something new – spontaneously joining a wild swimming group or an art session, for example.
But we all know that some changes stick, while others are simply a ‘flash in the pan’.
Making a change usually means giving something up. Even small changes can carry a sense of loss. Habits such as smoking, for example, can offer relief, routine or social connection. Stopping is not just about breaking an addiction – it can feel like losing part of who you are. That helps explain why change is so hard to sustain.
This applies far beyond smoking – to diet, activity, alcohol use and more. If we want lasting improvements in health, we need to recognise these personal and emotional factors. Change takes time, and it needs to be supported in a way that respects people’s lives and identities.
The ambition to prevent ill health will only succeed if we understand how change happens naturally in people’s lives and in our communities, so that we can support it more widely, more sensitively and often without any input from the public sector at all.
This is not just a challenge for the NHS; it is an invitation for communities, organisations and individuals to play a part.
Without that broader involvement, there is a real risk that an NHS-led approach alone will fall short – and we will end up with ‘you can’t get there from here.’
The Dorset Life Community News section is sponsored by Wessex Internet
