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The future of the NHS is in prevention rather than cure. And the mass application of genetic profiling can bring that about say Health Minister Hancock and his new best friend….

There are big changes afoot in terms of the government’s Public Health strategy. Although in these ‘turbulent times’ maybe we should always add the word “potentially”. Anyway, if and when the new government does decide to do some governing (rather than just playing dodgy constitutional games…) we can expect to see a serious push for the introduction of community-wide predictive genetic testing through the NHS.

Even amid all the recent turbulence, Matt Hancock is still in the Cabinet as Health Secretary. While his image as the politician who never met a principle he wouldn’t ditch has been quite widely discussed, his approach to health has been somewhat neglected. In fact, he has some very strong and quite radical ideas. Notably, he has nailed his colours to the mast on the issue of redirecting the NHS towards prevention rather than treatment through the large-scale introduction of genetic risk profiling.

The overall plan, initially laid out while he was still serving the May administration, is to use the kind of tests marketed by firms like 23 and Me to identify individuals who have a heightened risk (genetically speaking) of developing the big killer and disabling diseases. Identification at the personal level would allow behavioural and other preventative interventions to be individually targeted.

Hancock’s enthusiasm for the cutting-edge, hi-tech, ahead-of-now, sci-fi, feel of the plan is clear. He seems to sense in this an opportunity to reveal himself (possibly to everyone’s surprise?) as one of fellow Cabinet luminary Liz Truss’s really cool gang of “Uber-Riding-AirBnB-ing-Deliveroo-Eating-Freedom-Fighters.

Just a couple of weeks ago, as Hancock was assuming his latest political persona as a born-again, cliff-edge, ultra-brexiteer (where did that come from??), it was announced that his political right-hand person will be William Warr, a young Public Health academic from Oxford University, and erstwhile famous rowing man.  Warr is a strong advocate of the predictive genetic testing plan.

For Warr, the argument is plain and simple. Public Health needs to predict the occurrence of illness and stop it happening and it needs to do that on a case-by-case basis. DNA testing is “the best predictor around”.  It’s pretty cheap, so the NHS should use it and develop a new model of Primary Care based on personalised prevention. That bit still needs a bit of fleshing out, to be honest, but these are early days….

Significantly, Warr has already underlined the benefits he believes will accrue to those who will be identified as being at lower risk of cancers or circulatory diseases (etc). Specifically, their personal freedom will be enhanced because they will not be constantly propagandised by an intrusive Nanny State banging on about laying off the biscuits or doing Park Run or counting units or whatever. They will be free to get on and make whatever choices they fancy because they’ve got a green light. So everyone wins, really. This ‘libertarian’ twist to the policy will no doubt please the boss (no, I don’t mean Dominic Cummings… settle down and stop giggling at the back). And it may even turn a few favourable heads round the Cabinet table, when and if the time comes.

To be fair, Hancock’s genetics plan does represent a new and radical policy, even if many professionals in the field have been decidedly negative about it. Underlying the policy idea, however, is a political debate that remains substantially unchanged. For a long time, there have been two basic strands to the argument. A political strategy for Public Health needs to have a reasonably clear position on each of these two areas:-

  1. Should public health be based on screening, whereby those identified as being ‘at high risk’ are discovered and appropriate personal interventions made? Or should public health be based on general population intervention, in which ‘risk’ is collective?
  2.  Should prevention efforts be aimed at specific behaviours deemed to be under the voluntary control of individuals, or should prevention be based on infrastructural upgrading and the improvement of social, economic and environmental conditions?

The science behind all of this concerns the relative roles of the individual and the collective in causing and preventing illness. The policy implications are about what the NHS does and how people will experience it in the future. In the shorter term, it’s about where and how public money gets spent.

The contention of the Hancock/Warr proposal is that the availability of predictive genetic testing changes the balance and indeed the nature of all these arguments.

For the last thirty years and more, public health policy has been based on ‘general population’ as the answer to question 1 and ‘individual behaviour’ as the favoured position on question 2. What is now proposed is to move to a system based on ‘identifying higher-risk individuals and targeting them with personalised interventions’. 

It will be interesting to see if the opposition parties put together a genuinely opposing position. In my fevered lefty imagination, I see a progressive policy that will have a completely different approach to both 1 and 2 –  its twin foundations will be ‘identifying collective risks and intervening to improve economic, social and environmental conditions’. The mass distribution of predictive genetic screening kits won’t be figuring in my version. But given the left’s past predilection for eugenics, I wouldn’t be surprised if some misguided progressives get seduced by Hancock and Warr’s whizz-bang plan.