There is quite rightly a great deal of discussion about the public’s need to be active in the prevention of diseases that could ruin or even shorten their lives. It is of course much more sensible to, for example, lose weight before you get type 2 diabetes; or start an exercise programme before you get very depressed. But for many the motivation to do something to prevent the onset of something bad in the future is just not high enough. People don’t believe that it will happen, and given how hard it is to change their behaviour, don’t bother.

The NHS in general and British society in particular is becoming much more sophisticated in targeting its messages to very specific groups at specific times. Stop smoking just before an operation; start exercise on retirement etc etc. but still on a pound for pound basis the outcome of most of this investment does not show a brilliant return because people’s motivation is just not strong enough.