Climbing ladders: From treatment to prevention (2025)

Mick and Carol's family, and their stories, are fictional, but the way their lives are shaped by the building blocks of health, and the challenges they face when those blocks are missing or broken, is very real.

What's also true is how those building blocks connect, interact, and reinforce each other. When one building block comes crashing down it begins a chain reaction, damaging other building blocks and significantly impacting health outcomes and life chances.

When Mick's back injury becomes so severe that he can no longer work after years of heavy lifting, it is not only the employment building block that crumbles. The family's income falls sharply, daily life becomes harder, and Mick's relationships with Carol and Dan become strained. His self-confidence and identity are undermined, and stress and pain make healthy behaviours harder to maintain, leading to increased smoking and drinking. As one setback triggers the next, more building blocks fall away and Mick's mental and physical health deteriorate further. confidence and identity are undermined, and stress and pain make healthy behaviours harder to maintain, leading to increased smoking and drinking.

As one setback triggers the next, more building blocks fall away and Mick's mental and physical health deteriorate further. The 'Jenga effect' can also be seen in Maya's story. Just as removing one block can destabilise a Jenga tower, the breakdown of Maya's relationship with Dan weakens other building blocks needed for a healthy life. She becomes homeless and overwhelmingly stressed and anxious about how she will support and care for her new baby. Confidence and identity are undermined, and stress and pain make healthy behaviours harder to maintain, leading to increased smoking and drinking.

Mick's story shows that missing or broken building blocks don't just affect one individual, but the ripple effects can impact whole families and even generations. Intergenerational adversity is the cascading effect of challenges, such as mental ill health and poverty, passed down through families and communities with impacts on the wellbeing, opportunities, and outcomes of future generations.³² For Mick, this pattern is familiar. He followed his dad and grandad into hard manual work with modest pay, with insufficient health and safety provision, which contributed to early ill health and disability for all three generations. Heavy drinking was a normal way to cope with chronic stress, and retraining or changing careers never felt like an option.

Research on Adverse Childhood Experiences (ACEs)³³ tells us that children and young people who are exposed to adverse childhood experiences are at a greater risk of death or injury before reaching adulthood, and of premature mortality later in life. Dan's life has already been impacted by his dad's mental health difficulties and alcohol use. Maya's housing insecurity and severe anxiety has the potential to harm Isla's early development, physical and mental health, and future life chances sustaining the cycle of poverty and disadvantage into another generation.

Whilst nothing is ever set in stone, evidence tells us that for the best start in life and to make it less likely that hardship and poor health are passed from parent to child, families need access to stable housing, healthy food, and safe environments. The interventions that Dan and Maya, have been able to access, have already helped interrupt this intergenerational cycle of disadvantage.

Early childhood is where inequalities widen quickest. Through the Family Nurse Partnership and Family Hubs, steps have been taken to strengthen the building blocks Isla needs for a healthy start in life. This support benefits her now and will also shape her wellbeing over the years to come. For her dad, Dan, support to stay in education, and continue his apprenticeship, provided a pathway and opportunities for a stable career and income, strengthening the foundations for the whole family.

The stories of our Gateshead family show clearly that because the building blocks of health are so interconnected, people's needs rarely fit into a single category or service. Each person experiences overlapping challenges, at different stages of their lives, across money, housing, relationships, social connection, access to support and mental and physical health. No single issue can be tackled in isolation.

• poor housing worsens Sue's mobility and respiratory health
• Carol's caring responsibilities and financial stress lead to exhaustion and may also be contributing to her high blood pressure
• Dan's childhood exposure to alcohol and stress influences his emotional wellbeing and health behaviours into adulthood

Because these building blocks interact and reinforce one another, the interventions that genuinely make a difference are those that are flexible, person-centred and joined-up which combine social, emotional, practical, and clinical support.

Our Gateshead family also demonstrates why we need all levels of prevention - health creation, primary, secondary, and tertiary - working together and applied consistently across the life course. Health creation and primary prevention strengthen the building blocks of health by improving the conditions people grow up and live in, reducing risks before they take root. Secondary prevention identifies problems early and stops them from worsening. Tertiary prevention supports those already living with illness, disability, or adversity to maintain independence and quality of life. As people move through childhood, adulthood and older age, different levels of prevention become more or less important, but all are essential to interrupt the pathways that lead to poorer outcomes.

Mick, Carol, and their family show that effective prevention requires multiple sectors and organisations working together - health, housing, early years, employment, VCSE organisations and more - because people's lives are not lived in neat boxes.

Their stories make clear that prevention cannot be a single intervention at a single moment. It must be a continuous, flexible, whole system response to changing circumstances. By recognising the complexity of real life and responding with the right combination of support at the right time, we can prevent the broken building blocks of health from being passed down from generation to generation.

Prevention, across all types, has made a difference to everyone in our stories at different stages of their lives. Shifting prevention upstream to primary and health creation approaches delivers the greatest benefits. If we can do this and lay the foundations right, we can give baby Isla, and the other babies and children in Gateshead, the best chance of a healthy life. By strengthening the building blocks of health, we can improve the conditions that they grow up in, creating better outcomes across their lives.

Whilst we will never be able to remove every 'snake' they meet along their paths, effective prevention can reduce their number, lessen their impact, and make sure that the right 'ladders' are in place at the right time.

Prevention is not just a health strategy - it is a social justice imperative. Prevention is clinically effective, socially just, and economically essential. By acting across the life course and addressing the wider determinants of health through Marmot principles, the Building Blocks of Health, the prevention spectrum, and NHS strategic pivots, Gateshead can become a healthier and more prosperous place.