A health MOT is just one step towards prevention | Letters

Tackling social and economic conditions must come first, writes Dr Louise Lawson. Plus letters from James Hibberd, Bob Forster and Dr Giles Youngs

Devi Sridhar is right to welcome free cholesterol testing on the NHS in England and blood pressure checks in pharmacies. Such measures can help identify health risks earlier. However, I would take issue with her suggestion that a “health MOT” is “precisely what prevention is all about” (Free cholesterol tests on the NHS are great – but here’s the five-point health MOT I’d really like to see, 2 September).

Sridhar’s proposed five-point health MOT is undoubtedly valuable, but it is better understood as identifying risk rather than preventing disease. Prevention is what comes next: enabling people to make changes that improve health and reduce that risk. Public health has long distinguished between upstream factors, such as poverty, housing, employment, access to affordable healthy food and safe green spaces, and downstream interventions focused on individuals. Screening and health checks sit much closer to the downstream end of that spectrum.