A leading voice in public health has thrown cold water on the idea that routine medical MOTs can deliver genuine prevention, arguing that without bold action on poverty, housing and inequality, the nation’s health will continue to slide.
Writing in response to Professor Devi Sridhar’s widely-read proposal for a five-point health MOT, Dr Louise Lawson, a lecturer in social policy at the University of Glasgow, welcomed the expansion of free cholesterol testing on the NHS in England and blood pressure checks in pharmacies. But she insisted such measures only scratch the surface of what prevention truly means.
Risk detection is not the same as prevention
Sridhar’s five-point plan, which has sparked fresh debate about the future of preventive healthcare, identifies cholesterol, blood pressure, blood sugar, body mass index and fitness as key markers to monitor. Lawson accepts this approach has merit but argues it conflates two very different things: spotting risk and actually preventing disease.
“Prevention is what comes next: enabling people to make changes that improve health and reduce that risk,” she wrote.
Public health experts have long drawn a line between upstream factors — the social and economic conditions in which people live — and downstream interventions aimed at individuals. Health MOTs, Lawson suggests, sit firmly at the downstream end. They tell people what they might die of, but do little to change the circumstances that make them ill in the first place.
Individual responsibility is not enough
Behaviour-change campaigns, she warns, often assume everyone has the same capacity to eat better, exercise more or attend medical appointments. They do not. People on low incomes, those in insecure work, and those facing linguistic or cultural barriers frequently find healthy living far beyond their reach.
The result, Lawson argues, is twofold. Not only do such approaches fail those most in need, but they also shift blame onto individuals for health problems rooted in structural disadvantage.
The numbers are stark. In England, those living in the most deprived communities can expect roughly 19 fewer years of healthy life than their counterparts in the wealthiest areas. Free testing is welcome, she concedes, but it will not close that chasm on its own.
A GP’s warning from the frontline
Dr James Hibberd, a London-based GP, echoed those concerns from the consulting room. He backed Sridhar’s emphasis on early detection but warned that annual MOTs risk creating expectations the NHS simply cannot meet in its current state.
“Without substantial investment in general practice and community services, what happens after we identify millions more people with pre-diabetes, obesity, mildly raised cholesterol or borderline hypertension?” he asked.
Those patients, he noted, will rightly expect advice, support and follow-up. But the root causes of their conditions — poor diet, inactivity, substandard housing and poverty — cannot be resolved with a prescription or a leaflet.
Hibberd also cautioned that enthusiastic media coverage of routine health checks may encourage patients to book MOTs that are neither clinically necessary nor officially funded. At a time when primary care is buckling under intense pressure, he said, ramping up demand without boosting capacity threatens to pull resources away from those with the greatest clinical need.
“Prevention matters,” he concluded, “but calls for screening programmes must be matched by realistic plans for what follows.”
Lighter notes among the debate
Not every contributor took a grave tone. Bob Forster, writing from Shipton-under-Wychwood in Oxfordshire, offered a more whimsical objection: the press-up test. He urged Sridhar to reconsider including it, citing “those familiar and ignominious collapses on to a sweat-speckled floor” that haunt anyone who suffered through school PE.
Meanwhile, Dr Giles Youngs, a retired consultant physician from Drinkstone in Suffolk, struck a wry note about age limits. Having just turned 85, he noted with some amusement that he now falls outside the 40-to-84 bracket eligible for NHS cholesterol screening — leaving him, in his own words, “presumably fit only for the knacker’s yard.”
Why it Matters
This exchange lays bare a growing tension in modern health policy. Politicians and clinicians alike champion prevention, yet too often reach for screening as a quick-fix solution. The letters make clear that detection without follow-up, and advice without addressing the conditions that shape behaviour, amount to little more than a national exercise in counting problems rather than solving them. If Britain is serious about closing its yawning health gap, the argument goes, ministers must look well beyond the clinic and invest seriously in the social and economic foundations of good health.
