Domhnall MacAuley: Politics, health checks, and well meant good intentions

Domhnall Macauley
When a politician speaks with passion and commitment about social inequality, I listen. When it is the chairperson of the Committee for Health, Social Services, and Public Safety, I listen carefully. Our practice is in an area internationally recognised as socially deprived, and, if politicians took a genuine interest and were prepared to invest resources, it could transform healthcare and improve the lives of so many people. Recently, the chair and deputy chair visited Cuba and, like many before them, were greatly impressed by the Cuban health system where they achieve impressive outcomes with services based very much on the family doctor.

One of the ideas they brought back from this visit was the introduction of annual health checks. The chair proposed, and the NI Assembly agreed that it be mandatory that general practitioners provide annual health checks for their patients, to help promote good health and detect disease at an early stage. We know of the many health disparities related to social class and, I applaud the Assembly for their interest in targeting health and social need.

But health checks are not the way forward, and there is little evidence of any value. A recent systematic review (, published in the BMJ found that general health checks did not reduce morbidity or mortality, and among those research papers, were key UK studies. A BMJ editorial put it in context: “The history of health promotion through routine health checks has been one of glorious failure … We need to reinforce the message lest some enthusiast reinvent the health check in another guise. Policy should be based on evidence of wellbeing, rather than on well meant good intentions.”

The chair of the health committee is the MLA for West Belfast, and I agree with her wholeheartedly about the importance of addressing these health inequalities. I am acutely aware of these particular needs, because our practice is based in her constituency—where I have practiced for 28 years and where I grew up. But this research and BMJ editorial challenges the value of health checks … and I wrote the editorial.
Domhnall MacAuley is primary care editor, BMJ.