Climbing ladders: From treatment to prevention (2025)

Carol is worn-out. She juggles work, caring for Mick and her mam, and keeping on top of the family's money. She's also more stressed than she's ever been, as it's getting harder to pay the bills and do the food shopping with prices going up and up.

Carol used to have more energy, but lately she's been exhausted. Since Mick's accident, he's needed some help with small tasks, but these days, he also needs help to get showered and dressed.

She also takes care of Sue, her mam, after she had a stroke two years ago and now lives with balance issues. Carol loves her mam, but now feels responsible for her shopping, daily errands like laundry, and making sure she's eating well.

Despite keeping an eye on what her mam eats, she's taken to comfort eating after a long day and has recently noticed even her most comfortable jeans getting tighter. The weight gain doesn't make her feel better, even though the food helps to keep her going. She worries that she might end up with a heart problem, or even a stroke, like her mam. After eventually finding the time for a GP appointment to share her concerns, Carol got some tests done. She was prescribed medication to lower her blood pressure and reduce her risk of heart disease. She was also referred to the Social Prescribing Service to see a Link Worker, after hearing about her struggles.

The Link Worker had time to listen and understand what matters most to Carol. The Link Worker accompanied her to an appointment at Citizens Advice Gateshead, where she received guidance on Carer's Allowance, Universal Credit, and debt management. Citizens Advice also assessed the wider family's needs. Advisers explained benefit entitlements to Mick and Carol's mam and reviewed the household's finances. The Link Worker also introduced Carol to a carers' support group and free local health walks, going with her at first to help her feel less anxious.

Carol now feels more informed about her rights and benefits. Money is still a worry, but she feels more in control, which helps with the stress she's been under and the comfort eating.

She enjoys her weekly health walk and looks forward to the carers' support group, where she has made new friends and can get things off her chest with people who understand what she's going through.

The snakes and ladders in Carol's story

Snakes

Struggling to provide the basics for your family can cause constant anxiety and, over a prolonged period, may result in chronic stress, damaging both mental and physical health. When we have enough income, it's easier to access all the building blocks needed for good health. ⁶ 

Choices about what food to eat are shaped by environmental factors such as cost and availability (healthier foods are more than twice as expensive per calorie than less healthy foods and less available⁷) and personal circumstances, including the pressures we face. Stress can lead to comfort eating, making it harder to maintain a healthy diet and increasing the risk of heart disease.

Ladders

Carol was able to access social prescribing, to support her with the social and economic causes of her health problems, as well as the medical care that she needed. This is  increasing the chances of a sustained improvement in her health and wellbeing.

There is lots of evidence to show that exposure to green space, particularly urban, is associated with improved psychological well-being, physical activity and linked health outcomes.' Natural England, 2024.  One recent study found that an Increase in green space was associated with fewer preventable deaths in the most deprived neighbourhoods.⁸

Upping prevention

People need accessible and timely healthcare.  People also need support close to home from trusted organisations that can work with them to address the missing or broken building blocks needed for a healthy life. The renewed focus on place-based working, in the NHS, Council and partners brings new opportunities to transform prevention and reduce health inequalities.  Collaboration across the Council, NHS, VCSE and with communities is key to harnessing our efforts and make the biggest difference.

Why we should prioritise prevention

In 2023, more than 1 in 8 deaths (13.9%) in England were considered preventable at the time of death - that's 75,694 people. ¹⁷ Evidence suggests conditions such as chronic pain, type 2 diabetes and anxiety and depression contribute most to these inequalities ¹⁸ and all of these are amenable to prevention. Based on current trends we know that inequalities will persist over the next 20 years and that the burden will be felt most in our poorest communities.

Without preventive action these conditions will increase at a faster rate in poorer communities by 2040 with people in the 10% most deprived areas can expect to be diagnosed with major illness a decade earlier than people in the 10% least deprived areas:

Specific action on prevention is required to address these inequalities and that is why we should prioritise prevention. Because it's the right thing to do. It helps people stay healthy and live longer by reducing the chances of getting ill, or by stopping illnesses from getting worse. This means people can enjoy life more and live independently as long as possible. They will contribute more to their communities and to economic prosperity and high demand for treatment can be lowered. Prevention helps everyone, not just those already affected. Primary prevention works across whole communities, making health fairer and reducing inequalities. If we don't act, the health gap is forecast to increase.

It reduces stress, building stronger, more resilient communities. While stress is a normal part of life, too much of it for too long can harm both mental and physical health. Strengthening the building blocks of health - like enough money, safe housing, education, and social networks means people feel less stressed and are more able to cope with life's challenges. 

It saves money and resources. Preventing illness is often cheaper than treating it later, reducing pressure on health and services.

"Primary prevention is 3-4 times more cost-effective than investing in treatment. The return on investment (ROI) for £1 invested was £34 for health protection (for example vaccines and immunisation) and £46 for legislative interventions (for example the ban on smoking in public places.)"¹⁹

It has a wider economic benefit as people are more able to contribute to society through employment or other activity.

Prevention is often perceived as a cost, but evidence shows it is a high-value investment that reduces long-term health and social care expenditure, improves productivity, and strengthens local economies. However, we need to be wary of using return on investment as a measure.

Evidence shows that public health interventions are highly cost-saving, especially national and legislative measures, and that reductions in public health funding represent a false economy, likely leading to billions in additional costs for health services and the wider economy. The evidence strongly supports investment in prevention over treatment²⁰.

• Economic case
  Cost of preventable illness to NHS and social care (e.g., smoking £2.4bn, obesity £6bn). ²¹
• Evidence base
  Cost-effectiveness of public health interventions (e.g., measurable gains from prevention vs treatment). ²²
• Policy drivers
  Government vision for prevention, local strategies, and integrated care systems. ²³

National evidence

• Public Health ROI: For every £1 spent on public health interventions, there is an estimated £14 return on investment through reduced healthcare costs and improved productivity. ²⁴
• Smoking: Costs the NHS over £2.4 billion annually; effective cessation programmes deliver savings within 2-3 years.
• Obesity: Estimated cost to the NHS is £6 billion per year, projected to rise to £9.7 billion by 2050. Local prevention programmes reduce future treatment costs and disability burden.
• Mental Health: Early intervention for depression and anxiety saves £2 for every £1 invested by reducing lost workdays and healthcare use.

Local Gateshead context

• High deprivation impact: Poor health linked to deprivation drives demand for costly acute services. A&E attendances in England are significantly higher when comparison is made between 10% most deprived areas (18.8%) and 10% least deprived areas (5.3%) in England for high intensity use i.e. individuals attending A&E 5 or more times per year.²⁵
• Hospital Admissions: Preventable conditions (for example, cardiovascular disease, COPD) account for a significant proportion of emergency admissions. Across Gateshead and Newcastle emergency hospital admissions for acute conditions for male and female that should not usually require hospital admission were 1091 per 100,000 population, significantly higher than the national figure of 848 per 100,000.²⁶ Nationally evidence suggests as many as 6million (3%) emergency admissions to hospital due to preventable conditions such as COPD could be prevented.²⁷
• Workforce Productivity: Preventive action improves economic participation. There is a clear association between ill health and economic inactivity and equally good health driving improved economic activity. ²⁸²⁹ In Gateshead 31,000 people (24.4%) of working age (16-64years) are economically inactive compared to only 21% nationally (Oct 2024-Sep 2025).³⁰

Why invest now

• prevention reduces future demand on NHS and social care budgets
• supports economic growth by enabling residents to work and contribute
• aligns with Integrated Care System priorities for sustainability