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Domain England score England Interpretation Overall HICs score Overall HICs interpretation
Governance 86% Very high performance Click here for full results 73% High performance
Risk factors 60% Moderate performance Click here for full results 46% Moderate performance
Surveillance & research 79% High performance Click here for full results 57% Moderate performance
Health system response 88% Very high performance Click here for full results 90% Very high performance

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Worldwide perforrmance:

       - Very low performance ≤20%
       - Low performance 21%-40%
       - Moderate performance 41%-60%
       - High performance 61%-80%
       - Very high performance > 80%

Comments from Richard Smith, Chair, Patients Know Best

As in other high income countries, the NCD pandemic is not new in Britain, so there has been a long time to respond. Deaths from heart disease peaked in the 70s and have been declining ever since but are still the leading cause of death in men (15.4% of deaths). Deaths from stroke and chronic obstructive pulmonary disease have also long been falling. In contrast, diabetes and obesity have risen rapidly and continue to rise, and foreshadowing what is likely to happen to men, dementia and Alzheimer’s disease are the now commonest causes of death in women (12.4% of deaths).

Increasingly patients with NCD have not one condition but many. Multimorbidity has become the norm, presenting problems to a health system where evidence has been developed from studies that exclude people with multiple conditions and where guidelines are usually for one condition.
Inequality is a major problem in England with the wealthy living as much as 20 years longer than the poor.

As the results of the Scorecard show, the biggest potential for England to do better with reducing suffering and premature deaths is to act on risk factors—smoking, poor diet, physical inactivity, and the harmful use of alcohol.

Smoking rates have been steadily declining in England as a result of increased awareness of the risks, steady increases in price, and bans on advertising and smoking in public places. But still almost one in five adults smokes, with higher rates among those with the lowest incomes and those under 35. Further initiatives will be needed to reduce rates, including perhaps banning smoking in cars with children and promotion of smoking cessation programmes (possibly including use of e-cigarettes).

England has high rates of obesity and overweight (66% of men and 57% of women), and high rates of physical inactivity; around 60% of men and 70% of women don’t achieve recommended levels of physical activity (150 minutes of moderate activity each week). Policies are needed to improve diet and promote physical activity. England has done well at steadily reducing salt consumption through a voluntary agreement with food producers, and something similar might be done for sugar. There is discussion of a soda tax, but it would need to be high and might easily have unintended consequences. But Britain should ban trans fats, as other countries have done. Physical activity levels are probably best increased by promoting cycling, walking, and the use of public transport, and many cities in England have a variety of schemes.

Per capita consumption of alcohol has declined in England in recent years, but at about 10 litres/head a year England is still one of the heaviest drinking countries in the world. About half of men and half of women who drink alcohol consume more than the recommended limits (three to four drinks a day for men and two to three for women). The government has been more reluctant to increase tax on alcohol than on cigarettes, and cooperation with the drink trade to promote sensible drinking has been controversial. England needs to do more to reduce alcohol consumption.

The National Health Service, which provides care that is free at the point of care to everybody, is under great strain dealing with the rise in NCD, elderly people, and multiple morbidity. NHS England has now recognised the need to encourage prevention and workplace health. Action on risk factors together with making a polypill containing antihypertensives, a statin, and (for some patients) aspirin available might be a good way to reduce further deaths from cardiovascular disease.

Executive report

Full report