Within the United Kingdom, population screening to identify and treat those at high risk does not seem to be successful in controlling vascular disease. Many people at high risk remain undetected, and a survey of 1300 patients known to be at high risk within a representative sample of practices across Wales in 2003 found that only about half (53%) were taking aspirin.
Health promotion initiatives seem to achieve little behavioural change in the general community,15
and without additional social support, health education seems effective only in higher social classes. Although not an alternative to health promotion, nor a substitute for the appropriate treatment of high blood pressure, raised blood lipids concentrations, etc, the possibility that a simple, daily, inexpensive low dose pill would achieve a reduction in vascular disease events, and might achieve reductions in cancer and dementia, without the need for screening, deserves serious consideration.
Although we judge that aspirin should be taken from around 50 years, we recommend wide discussions on the threshold that include the general public, and we insist that the general public should be well informed and the final decision should lie with each person. Such discussions would not only fulfil the recommendations in the recent white paper that “people should make their own choices... but these choices should be informed by good information and advice about the choices available... to help people make and carry out the right decisions for their own health.”16
They would also help meet expectations expressed by members of the public questioned in a recent King's Fund survey.17
Eighty six per cent of respondents said that information should be provided to the general public, and half said that the NHS should provide information, advice and support “To enable everyone to prevent illness and lead healthier lives.” In fact, what we recommend would help put the public back into public health.—Peter Elwood, Gareth Morgan, Ginevra Brown, Janet Pickering