'Of their nature, 'health statistics' relate to morbidity and mortality, not to 'positive health', which in a euphoric passage we define as a 'positive expression of vigour, well-being and engagement in one's environment or community'.'
The HQ concept could be an integral part of a preventive screening programme. Screening specific groups for cervical and breast cancer is already justified, by smear and X-ray mammography respectively, as is measuring blood pressure to detect hypertension (a Black Report recommendation) and assessing blood cholesterol for predisposition to coronorary heart disease. Furthermore, a battery of tests is becoming available from biotechnology companies that enables identification of those who are most likely to succumb to common conditions such as diabetes, emphysema, heart disease, several cancers and even, it is said, alcoholism, long before they actually do so. New pregnancy tests have been developed enabling the identification of genetic disorders such as cystic fibrosis and Huntingdon's Chorea. A new generation of 'physician office' diagnostic tests are arriving. Among these is a kit allowing plasma cholesterol to be determined in two minutes using a pinprick blood sample. Screening is an idea whose time has come - particularly combined with an HQ component which leads to the adoption of healthier lifestyles.
The HQ part of the screening process might well comprise three stages: a preliminary questionnaire, the test itself, and a follow-up interview. The pre-test questionnaire would seek to establish dietary pattern, behaviour, social circumstances, typical levels of psychological stress, information on vaccinations previously received, present and previous illnesses and disabilities, and use of health service facilities in the recent past. Also obtained would be information relating to disease and death among the subject's parents, grandparents and blood relatives to establish the genetic background.
The HQ test itself would be a comprehensive 'medical'. Conventional height, weight and other measurements would be made together with hearing and eye tests, and so on. Blood and urine samples would be analysed. The hapless punter would also be subject to 'treadmill' exercise stress tests with computer assisted monitoring to assess cardiovascular and lung function. Other screening assessments would be made in what would clearly be an extensive test schedule.
The follow-up interview would inform the individual of the HQ findings and identify the potential for improvements, focusing on key risk factors relevant to that person. The 'sub-100' subjects would be given particular attention in this regard. The intention would be to develop a Personal Programme for Risk Reduction, covering diet, exercise, etc. The opportunity could also be taken to give information, where appropriate, on family planning, sexual diseases including AIDS, dental hygiene, availability of NHS and personal social services, sickness support groups (of which there are almost 9,000, including one for people with diseases so rare they thought no one else had it), local sporting activities, counselling services, welfare benefits (eg heating grants), accident prevention and so on. The HQ follow-up could also be used to improve immunisation take-up relating to polio, measles, rubella and whooping cough.
Who to screen? A representative sample of the entire population, and members of high risk groups. The representative sample would enable a 'national HQ' to be determined. This would provide the basis for determining progress against a target of a 10 per cent improvement in Britain's health by the year 2000. It would also facilitate broad-based international comparisons in the health sphere in the way that GDP figures permit in the economic sphere. It will have a further advantage: it will enable us to determine 'productivity' in the health business in terms of the HQ score added by a certain measure, health team or hospital.
Dr John Hart, 16 Burleigh Court, Cavendish Place, Brighton BN1 2HR (tel 0273 720879).