Sunil Bhopal, Guppi Kaur Bola, Robert Hughes, Anya Gopfert and Anand Bhopal


Bhopal, S., Bola, G. K., Hughes, R., Gopfert, A., and Bhopal, A. (2020) 'Can we improve the NHS’s ability to tackle covid-19 through emergency public health interventions?'. The BMJ Opinion

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Can We Improve The NHS’s Ability to Tackle Covid-19 through Emergency Public Health Interventions?

Scientific opinion


In the current attempt to stop healthcare services from being overwhelmed from covid-19, the major focus has been on both “flattening the epidemic curve” and scaling up intensive care capacity. There is a third major approach with potential benefits: “reducing the baseline” demand for NHS acute services through the rapid introduction of public health policies. The article discusses 4 public health policies which can reduce the burden on healthcare.

  1. An immediate reduction in motor vehicle speed limits
  2. Accelerating current commitment to reduce tobacco smoking
  3. Implement minimum unit pricing (MUP) for alcohol
  4. Extend the Warm Home Discount Scheme to all households through Spring 2020

In England alone there are around 35 000 non-fatal admissions to hospital every year related to road traffic accidents; more than one in 10 of these are serious and likely to require intensive support, including anaesthesia and surgery. Evidence from around the world shows that lowering speed limits can lead to major reductions in injuries. The recommended reduction is all national speed limits to 50mph, and to 20mph in urban areas.

Tobacco smoking is responsible for nearly half a million hospital admissions per year, representing 22% of all admissions for respiratory diseases.  In the aftermath of Scotland’s introduction of legislation outlawing smoking in enclosed public places, there was a rapid 20% drop in hospital admissions for acute coronary syndrome in men over 55 years and women over 65 years. The World Health Organization has also indicated that tobacco use may be a risk factor for developing more serious symptoms from covid-19.

Alcohol use is associated with accidents, injuries, and violence. In Scotland, the introduction of minimum unit pricing had an immediate impact in reducing alcohol purchases and, by inference, consumption. This measure has already been implemented in Scotland with positive effects and recently implemented in Wales.

It must be ensured that homes remain warm and that isolation does not exacerbate pre-existing disease. Fuel poor households are often more expensive to heat, fuel inefficient, and home to older people with more pre-existing health conditions. The government Warm Home Discount Scheme, which offers payments to certain groups during winter, could be extended to all households through spring 2020.

The authors encourage Public Health England and equivalent bodies in other nations, chief medical officers, and the Scientific Advisory Group for Emergencies (SAGE) to examine these and other emergency public health measures to reduce the burden of non-covid-19-related disease on the NHS.

Source Website: BMJ