"Prevention" is the fast-becoming the most fashionable answer when it comes to addressing how we make the NHS sustainable for the future.

This is not a problem for the UK alone.

Healthcare systems in every western nation, however they are funded, are grappling with the dilemma of how to pay for ageing populations where people are spending many more of years in chronic ill health and obesity.

All while the working age, taxpaying share of the population shrinks in proportion to the over-65s.

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There is a growing clamour that unless we start diverting resources into preventing avoidable lifestyle-related disease and early detection, there will be nothing left to invest in advances in medical technology and infrastructure - and economic productivity will nosedive.

In July, Professor John Deanfield - the first-ever government champion for personalised prevention - called for the creation of a "pre-NHS" focused on preventative healthcare.

Evidence-based interventions based around weight, blood pressure, and cholesterol could deliver "a 33% reduction in ill health" and an estimated boost to GDP of around £320 billion over 20 years, said Prof Deanfield.

He added: "A reorientation towards prevention is the only way to avert the growing health and wealth crisis.”

Such messages have been reiterated by the likes of former Prime Minister Tony Blair's think tank, the Institute for Global Change, which has couched interventions in terms of "proactive early detection": population screening for bad cholesterol, high blood pressure, and BMI to reverse the likes of diabetes before it happens; cancer blood tests to pinpoint signs of tumour DNA; using genomics and artificial intelligence to calculate a lifetime risk score and "create personalised prevention plans".

Tony Blair with now-PM Keir Starmer, who spoke at the Institute for Global Changes's Future of Britain conference in summer 2023 (Image: PA)

It pointed to Inclisiran - twice-yearly injections shown to halve levels of 'bad' LDL cholesterol and available on the NHS patients who do not respond to statins.

Caring for patients following a stroke can cost the health service as much as £45,000 over a five year period; why not "vaccinate" more patients against heart disease and stroke instead?

And this week, there was the suggestion from UK health secretary Wes Streeting that a new generation of "weight-loss injections" - collectively known as GLP-1 inhibitors - could be targeted en masse to unemployed adults living with obesity to help them get back into work.

"The NHS can’t be expected to always pick up the tab for unhealthy lifestyles," wrote Streeting in the Telegraph, as he announced a £279 million collaboration with pharmaceutical giant, Lilly (the manufacturer behind Mounjaro), to explore "new ways of delivering health and care services to people living with obesity".

Weight loss injections used to treat obesity and diabetes have also been shown to substantially lower the risk of cardiovascular events such as heart attacks and strokes, and overall mortality (Image: Getty) Beyond treating weight-loss and diabetes, major research trials have already demonstrated that these kinds of drugs also substantially reduce the risk of heart attacks, strokes, and all-cause mortality - although they are not without potential side effects (stomach paralysis, pancreatitis, suicidal ideation) and it is still unclear whether there are any additional complications from long-term use.

Nonetheless, as First Minster John Swinney put it when discussing future trajectories for the NHS, early intervention and prevention can "pay big dividends down the line".

The trouble, as always, for governments is how to shift spending towards initiatives which might bear fruit years, or decades, to come while health and care budgets are squeezed in the here and now.

One project seeking to transform the ability of the UK to address prevention is Our Future Health, which has just passed the milestone of recruiting over a million fully-fledged participants, making it the world's largest ever longitudinal cohort study.

The current model of care sees 50 per cent of cancer diagnoses occurring in A&E, and 10% of healthcare expenditure concentrated in the final year of life (Image: OurFutureHealth) 'Precision public health' is the idea that risk prediction and health screening should be used to detect pre-symptomatic disease and intervene at a much earlier stage (Image: OurFutureHealth) It comes weeks after it began its expansion into Scotland, with pop-up clinics in community pharmacies, shopping centres, and supermarket car parks.

The goal in Scotland alone is to recruit 500,000 people - nearly 10% of the population.

Those who take part complete questionnaires on demographics, household income, occupation, education, lifestyle, family history and personal medical history, as well as providing a blood sample for DNA analysis.

As a collaboration between the NHS, life sciences sector, academics and charities, the long-term goal is to "help people live healthier lives for longer through better prevention, earlier detection, and improved treatment of diseases".

On an individual basis, participants will get their own personalised disease risk profile.

But the bigger hope is that it will enable researchers to unravel new ways to spot disease early by cross-referencing genetics, blood biomarkers, and lifestyle against subsequent diagnoses. 

This could be particularly revealing for cancers where no accurate screening tools are currently available.

The Our Future Health projected expanded into Scotland in August. It is free to sign up, and open to anyone living in the vicinity of an OFH clinic (Image: OurFutureHealth) Speaking at a media briefing on Wednesday, Professor Michael Cook, an epidemiologist and the project's executive director of science, told the Herald: "The scale of Our Future Health will really be a game changer here.

"Because the question you really want to ask is 'can we look at bloods that were collected two to five years prior to that cancer diagnosis?', because that's the window in which you want to develop and validate a biomarker test specific to your disease."

Dr Raghib Ali, chief executive for Our Future Health, added that the data collected should also move the NHS beyond age-based cancer screening programmes towards "risk-stratified screening programmes" guided by genetic susceptibility.

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Professor Dame Anna Dominiczak, chief scientific adviser for health to the Scottish Government, warned that without prevention the "burden on the system will become impossible".

In Scotland alone, the burden of disease is projected to soar 43% by 2043, yet there are an estimated 1.4 million Scots currently living with undiagnosed or poorly managed hypertension - something that is "really easy to treat".

Our Future Health, with its blood pressure checks, should go at least some way to identifying many more of them.

Professor Dame Anna DominiczakProfessor Dame Anna Dominiczak (Image: ScottishGovernment) Prof Dominiczak also pointed to the example of Estonia, where young to middle-aged adults had their cardiovascular risk score calculated with the help of DNA analysis on top of other measurements to create an 'integrated risk score'. 

She said: "Large numbers, more than a 1000 people, who were informed about their risk score and had digital and face-to-face help from clinicians over 12 months reduced their risk significantly. 

"If we could do something like that in the UK, particularly for me in Scotland, I think that would be research going into clinical practice very quickly; precision public health becoming a reality."