Community health and primary health care: the value of home visitation (2)

5 September, 2021


I worked with a family practice list of patients in a low socio demographic population in the North of England for 14 years. My patients were and still are dying 9 years earlier than patient populations 10 miles down the road. My feeling was that I had to alter the patients' culture and lifestyle to increase their life expectancy and not the quality of the hospitals or number of doctors. The basic assumptions, norms, artefacts and values of the patients that we tried to change were that patients and their families were the greatest contributors to health and not the doctors and hospitals. We set up training and patient participation groups and gave patients Open Notes and tools with which to understand and navigate their health and notes.

Here is a recent 2019 article by Tina Woods in "Innovation" on the dropping of life expectancy in Western Countries despite expensive "health" services.

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Falling Life Expectancy Becoming The 'Climate Change' Of Health

Tina Woods

'I write about the impact of technology on health, life and society

'It’s official. Despite the incredible strides we’re seeing in science and technology, life expectancies are stalling or even falling in much of the developed world. Recent statistics from the Centers for Disease Control show life expectancy has fallen for the third year in a row in the U.S. There are ominous signs the U.K is heading in the same direction with growth in life expectancy stalling—according to the New York Times - after years on the upward trajectory.

'The challenge of the aging society is fast becoming the “climate change of health care.” So says Brian Kennedy, director of Singapore’s Centre for Healthy Aging. As with global warming, he argues, many of the solutions rest on changing people’s behaviour-modifying diet and other lifestyle habits. But as with global warming too, much of the world instead seems to be pinning its hopes on a technological fix.

'So, with all this investment and promise, why is life expectancy faltering or even falling? The U.S. spends roughly twice as much as other rich countries on healthcare yet has the lowest life expectancy. As the U.S. has become richer, inequality has also soared - inequalities of wealth have become inequalities of health.

'A similar trend is emerging in the U.K. National Health Service (NHS) is free for all at the point of delivery so why then have deaths in the U.K. been rising more than expected since 2011? The NY Times says that for the “first time in modern history, Britain's gains in life expectancy have stalled, with alcohol and drug abuse, poor diet, obesity, smoking and a lack of exercise taking their toll.” The latest figures from the U.K. Office for National Statistics affirm this, and Britain has slipped down the ranks with lower life expectancy than other European countries, including France, Spain and Italy. The level of inequality between the least and most deprived communities is significant- the "gap" is 9 years for life expectancy and 19 years for healthy life expectancy. Experts say the reasons behind the figures are complex but some blame government austerity and many agree income and wealth are factors in the slowdown.'


HIFA profile: Richard Fitton is a retired family doctor - GP, British Medical Association. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data. Email address: richardpeterfitton7 AT