Notably, 90% of deaths from non-communicable diseases are a result of five common diseases: cardiovascular diseases, cancers, chronic pulmonary diseases, digestive diseases, and diabetes. From a biomedical perspective, says James, in efforts to reduce mortality and morbidity and increase the health of populations, the medical establishment focus predominantly on the proximal biological causes of these diseases and thus spend most of the health budget (i.e., 95 – 96% in the UK and U.S) on treatments (e.g., surgical, pharmaceutical) that are proximal to the onset of disease. But James notes that non-communicable diseases develop over time and a medical focus on biological causes and treatments that are proximal to the onset of disease neglects the distal causes of disease and investment in the prevention of diseases. James reviews a mass of research evidence, across multiple chapters, which highlights that treating individual cases of disease has little impact on the population burden of disease. Furthermore, it often is of limited benefit even for individuals treated and there is often significant medical harm that results from failures of biological treatments. Conversely, whole-population risk factor reduction and investment in preventative interventions reduces the risk of disease for everyone, evidenced by increased health overall and fewer cases of manifest disease. As people live longer, James argues that population-wide expansion of morbidity from the failure of success of biomedical healthcare may be keeping many people alive in poor health. But there is an alternative: compression of morbidity, where people live longer and healthier lives. As convincingly argued by James, compression of morbidity is a more likely outcome of population-wide preventive healthcare, and is clearly the more preferred scenario for both humane and economic reasons.
The World Health Organisation (WHO) Health in All Policies Framework for Country Action, recognises that governments must contend with wide-ranging responsibilities that compete for priority and may sometimes conflict with population health objectives. The Framework highlights that the main determinants of personal and population health have environmental origins that lay mostly outside the direct influence of the healthcare sector in the personal, social, cultural, and economic lives of people. Population health is thus influenced by policies and decisions across all spheres of government. WHO, thus, asks governments to ‘health proof’ all government policies. The new focus is squarely on health promotion, specifically, enabling people to increase control over their health and its determinants, and thereby improve their health.