Revealing the clues to preventing ill health

25 March 2019

Leeds has launched a groundbreaking new study to spot the risk of disease before it starts. But what does this mean beyond the laboratory? Diane Burke, Head of Public Health for Long-term Conditions, Leeds City Council, explains how this could benefit local people’s lives.

In Leeds, we talk about the ‘left shift’. It’s not a political reference. It refers instead to a position on a theoretical line – left to right. Left represents being in good health and, as you move towards the right, your health deteriorates, or so the theory goes.

Since before the NHS or social care services existed, most kinds of health-related investment have been disproportionately weighted on the ‘right’ end of that line. In other words, most of our precious resources are invested in dealing with ill health once it manifests.

From outstanding skills and knowledge, cutting edge technology and tender compassion to lifetime careers in caring for others, we are indomitable in our mission to help people recover. Such investments are impressive but costly.

For example, the cost of diabetes to the NHS is over £1.5m an hour or 10 per cent of the NHS budget for England and Wales. This equates to over £25,000 being spent on diabetes every minute.

In total, an estimated £14 billion pounds is spent a year on treating diabetes and its complications, with the cost of treating complications representing the much higher cost.

And the prevalence of diabetes is estimated to rise to 4 million by 2025.

In fact, according to the Harvard School of Public Health

If type 2 diabetes was an infectious disease, passed from one person to another, public health officials would say we’re in the midst of an epidemic.

But, as Harvard also notes, the good news is that type 2 diabetes is largely preventable.

We know more people are living longer but not necessarily healthier lives. We need a shift in the way care is provided. The Leeds Health and Wellbeing Board strategy recognises that the emphasis in healthcare must now change to being much more about preventing ill health. The investment needs to shift dramatically. To the ‘left’.

What makes a person move along that theoretical line from left to right? From good health to poor health? Is it genetics, social, economic and environmental factors or their lifestyle?

What if we could look inside a person and see a potential illness or long-term health condition before it even starts? Could we then help them take action to avoid it?

That’s exactly what the Leeds Centre for Personalised Medicine and Health is doing in a new study in Leeds. Public Health within Leeds City Council, along with the NHS Leeds Clinical Commissioning Group have been involved in the study design and implementation since the outset and are keen to ensure support and engagement of stakeholders and GP Practices in Leeds.

From those invited to take part in the study, we are taking a small sample of their blood and looking at it for clues.

By analysing the levels of 5,000 specific proteins in their blood, the test – developed by US biotech company SomaLogic – can identify that person’s likelihood of developing diseases such as diabetes.

This is an exciting step for the city’s approach to healthcare. We are doing exactly what the Secretary of State for Health and Social Care recently described in: Prevention is better than cure

We are testing new ways of providing people with preventative advice, using cutting edge technology often called ‘predictive prevention’.

But, as his paper also states, we all have role to play in aiming to lead healthy lives. So it’s what we do with those test results that really matters.

Our community-based colleagues are ideally positioned to provide the care and support for people taking part in this study. They can help participating people understand the test results and offer a collaborative and supportive approach about ways to avoid the risk of disease which this study may have revealed.

It might be as simple as making changes to their eating habits or finding suitable and enjoyable ways to exercise more.

People can also be referred to the Healthier You _ National Diabetes Prevention Programme where they receive tailored, personalised support to reduce their risk of Type 2 diabetes. This could include education on healthy eating and lifestyle, help to lose weight and physical exercise programmes, all of which together have been proven to reduce the risk of developing the disease. This is one way of personalising healthcare.

Once the study has been evaluated, if successful, it will be rolled out across the city and possibly beyond. That means, we’ll have been part of influencing the health of whole populations.

It’s a new way of investing. It means changing the way we think, work and live. It means all of us focusing more on helping people prevent ill health before it starts and care for themselves better. And gradually, it all counts towards making that ‘left shift’.

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Diane Burke is Head of Public Health for Long-term Conditions, Leeds City Council

Hosted by the University of Leeds, the Leeds Centre for Personalised Medicine and Health is a project of Leeds Academic Health Partnership. It is working on this study with US company SomaLogic, Leeds Teaching Hospitals Trust, Leeds City Council, NHS Leeds Clinical Commissioning Group and local GPs to recruit 1,000 patients from up to 24 general practices in Leeds.

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