TY - JOUR T1 - How to move from managing sick individuals to creating healthy communities JF - British Journal of General Practice JO - Br J Gen Pract SP - 8 LP - 9 DO - 10.3399/bjgp19X700337 VL - 69 IS - 678 AU - Luke N Allen AU - Eleanor Barry AU - Claire Gilbert AU - Rory Honney AU - Eleanor Turner-Moss Y1 - 2019/01/01 UR - http://bjgp.org/content/69/678/8.abstract N2 - The NHS is one of the most valued institutions in the UK1 but its sustainability is threatened by a heavy bias towards managing illness in secondary care. The Wanless report2 and the Five Year Forward View3 and upcoming NHS Long Term Plan all argue for a reorientation towards keeping people well through community-level prevention.Community-level prevention involves taking a localised approach to addressing the social determinants of health, which include housing, living and working conditions, education, food, and social networks.4 The strength of social relationships, for example, is a significant risk factor for mortality, as stronger relationships are associated with a 50% increased likelihood of survival than those with weaker social relationships.5 These non-medical ‘causes of the causes’ account for up to 90% of health outcomes6 and GPs see them at work in their patients’ everyday lives.7 Despite the fact that individual lifestyle choices are heavily constrained by deeper socioeconomic conditions, the dominant political health narrative emphasises individual-level ‘healthy choices’ above societal change.Less than 5% of the current health budget is spent on prevention8 and the 2012 Health and Social Care Act left overstretched public health teams with responsibility for addressing social determinants.9 Factors like fast food outlets, cheap alcohol, dangerous traffic, air pollution, and the lack of affordable fruit and vegetables drive up the prevalence of chronic disease. Left unchecked, these factors increase consultations, costs, and complexity for local GPs. General practice holds responsibility and financial risk for the health of listed populations, but does not have the means to address the ‘upstream’ non-biomedical factors … ER -