Every contact counts

Source: NHE Nov/Dec 15

Annie Anderson Professor Annie S. Anderson, professor of public health nutrition at the University of Dundee and co-director of the Scottish Cancer Prevention Network (SCPN), says the NHS can become an exemplar in the promotion of healthy living.

There has never been a better time to stop scaremongering about diet and cancer and to start sharing the good news! Several trillion pounds have been spent on researching the causes of cancer and we now know how to reduce the risk of cancer by around 25-30%. If we had a drug that could achieve this degree of risk reduction, there is no doubt it would be extremely well marketed. But, we are still a very long way from chemo preventive agent(s) and it seems unethical to sit on our expensively acquired knowledge and fail to apply it. 

Recent predictions for cancer incidenceshow we need to take urgent action to stack the odds against the occurrence of a disease that is the country’s major fear, which usually requires therapies with unwanted side effects and that may produce long-term symptoms and reduce quality of life. The details of how to reduce cancer are well set out in the European Cancer Code against Cancer, which covers the evidence base, frequently asked questions and simple messages. 

Taking action to support lifestyle change is everyone’s business – not just every individual but also stakeholders: retailers, education, media, government and many others including the health service. It is certainly clear that the population is likely to remain ignorant about the application of current knowledge if we wait for the media to deliver helpful messages given the recent way that processed meat has been so badly presented by the ‘bacon defence league’.

There is widespread recognition that health promotion is central to healthcare provision, but the potential for healthcare systems (including hospitals and clinics) to promote appropriate initiatives beyond smoking cessation – such as diet, physical activity, and body weight – is undeveloped. Recent initiatives such as the ‘health promoting health service’ and ‘every contact counts’ (1, 2)provide a framework to develop and support lifestyle change relevant to cancer risk reduction (which also impact on the incidence of diabetes and vascular disease) in patient consultations. 

Starting the conversation about modifiable risk factors against cancer occurrence makes sense – after all, we can’t do anything about our genetic risk. Physical activity confers many health benefits and is often the area that NHS staff feel most comfortable discussing. It is indeed an excellent starting point – highlighting that even a 10-minute lunchtime walk can make a difference to physical and mental wellbeing. 

However, the real elephant in the room is body weight. Most people are very familiar about the risk of smoking and cancer, but fewer are aware that excess body fat is the main modifiable risk factor for reducing cancer in non-smokers. It is estimated that over 700,000 NHS staff are overweight and it may be difficult to raise this topic with patients when the problem is so widespread. Health promotion communications can be brief – often simple endorsement by a clinician is enough to stimulate action for behaviour change, even better if support can be provided. 

For example, in the impact of a body weight and physical activity weight loss intervention (BeWEL) study (3), clinicians endorsed lifestyle change (by letter) and offered overweight patients who had been diagnosed with an adenoma the chance to engage in a lifestyle trial. Interestingly, 49% of patients expressed an interest in participation; the completed trial demonstrated successful weight loss and 91% of participants stayed in the study for the 12 months required. The rationale for the study was based on the concept of ‘teachable moments’ and clearly there are many such opportunities within the NHS – for both patients and staff! 

Healthy Meetings

The Scottish Cancer Prevention Network was established to help promote and facilitate behaviours for cancer risk reduction. One recent campaign has been aimed at worksite health (including NHS premises). The #healthymeetings initiative has focused on meetings lasting more than four hours where food is served. Supporters of the initiative are asked to use a scorecard to feed back to meeting organisers a score based on 10 factors (e.g. active transport directions, encouragement to break sitting time, visible fruit availability, visible vegetable portion, mostly wholegrains etc). Such an initiative helps to show staff demand for healthy ways of life on worksites and demonstrates commitment and effort for the changes needed to improve our all too obesogenic environment. 

The time to share positive news about reducing disease that isn’t all drug-based is long overdue. The NHS can be an exemplar in both the promotion of healthy living advice and healthy environments. Innovative and fun campaigns can help get people involved – we are all needed to do our bit!


  1. Health Promoting Health Service. Overview (2009). 2013.
  2. The NHS’s role in the public’s health. A report from the NHS Future Forum. 2013.
  3. Anderson AS, Craigie A, Caswell S, Treweek S, Stead M, Macleod M, Daly F, Belch J, Rodger J, Kirk A, Ludbrook A, Rauchhaus P, Norwood P, Thompson J, Wardle J, Steele RJC (2014) The impact of a body weight and Physical Activity weight loss intervention (BeWEL) initiated through a national colorectal cancer screening programme. BMJ;348:g1823

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