Welsh screening plan 'will not work'

Plans to target vascular screening at high-risk groups in Wales could do more harm than good, a public health expert has warned.

Cardiovascular screening: best approach is unclear (Photograph: Jason Heath Lancy)
Cardiovascular screening: best approach is unclear (Photograph: Jason Heath Lancy)

The recommendation to target high-risk groups was made in a report published by the Welsh Assembly government last week.

Such an approach would reduce health inequalities, as low socio-economic status is a major risk factor in vascular disease, the report said.

However, Professor Simon Capewell of the Department of Public Health at Liverpool University said that a targeted approach could actually widen the gap between rich and poor.

Professor Capewell published research last week showing that targeting high-risk individuals is 'a relatively ineffective approach that typically widens social inequalities'.

He said that, although recommendations were well intentioned, they ignored the evidence.

'This sort of screening approach has major shortcomings; it is ineffective and inefficient, and it costs money rather than saving it.

'The biggest problem is that policy makers would be able to say "mission accomplished", and would be under less pressure to bring in legislation, which is what they need to do.'

Professor Capewell said that a whole-population approach, including taxation and legislation to reduce salt and fat intake, is the only meaningful way to tackle vascular disease.

He said research by NICE has shown that banning trans-fats would prevent 10 times as many deaths as screening and that reducing salt intake by 2-3g could prevent 30 times as many.

But Dr Hilary Fielder, executive director of public health services for Public Health Wales, said that public health can be tackled at different levels.

'There is always a lot of debate between a universal approach and skewing resources towards the most deprived,' she said. 'You can't ignore policy advice or community projects. Both can work.'

  • PLoS Medicine Online 2010

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