By global health researcher Christopher Exeter

There are two things which are important…with cancer. One is investigation and the other is the education of the public so…they…understand the necessity of consulting [healthcare professionals] when the very first symptoms appear and when it is not too late to treat them.' 

Hard to disagree, especially as the UK has, according to Cancer Research UK, one of the highest incidence rates of cancer in Europe. However, these words were not said this year, not last year, nor even in the last decade. They were said in 1926 by then minister of health Neville Chamberlain - whom the historian Lord Lexden has called ‘the….minister of health …[who] prepared the way for the whole nation being brought under medical care through the NHS'- to a House of Commons committee.

Yet almost 100 years on the same arguments are still being made: the importance of early detection of disease and increased public awareness. Across all main non communicable diseases (NCDs) identifying the cause and screening for symptoms will, according to Sir Muir Gray, at Live Long Better, ‘increase healthy life expectancy' and result in ‘savings in both health and social care costs' while allowing people to ‘continue to make a contribution to the economy'.

One of the major forces impacting health systems globally is workforce shortage. The World Health Organization (WHO) estimates there will be a shortfall of 10m health workers by 2030. All countries face difficulties in the education, employment, retention and performance of the workforce, WHO says. So what can be done to both increase disease awareness and prevention and workforce supply - at pace?

Community health workers (CHWs) play a key role in improving healthcare efforts and reducing costs by addressing the social determinants of health.

CHWs - commonly found in low and middle income countries - are lay people who receive training to perform screenings, triaging, disease management and supporting maternal and child health or providing social care assistance. For high income countries struggling with scarce resources and the continued rise of NCDs, CHWs offer an approach to broaden access to the health system. The US has integrated CHWs into healthcare settings to advance health equity in hard-to-reach communities. There have also been limited pilots in the UK.

Middle income countries show how relatively low-cost innovations, such as CHWs, can be introduced and rapidly scaled up. Mutual learning across countries can support health system sustainability, regardless of income or universal health coverage status. This was seen most recently during the Covid pandemic, where the West's initial lacklustre response was in stark contrast to South East Asia's, which learnt from SARS-CoV-1 in the early 2000s. The West belatedly scrambled to learn Asia's lessons. Alongside workforce - opening access for point of care testing by the public is long overdue. In adversity, health systems often delegate diagnostics to the public - this was seen in the UK with home testing for Covid symptoms, and previously with the National Flu Pandemic Service, a phone and online diagnosis and treatment facility, during the H1N1 pandemic in 2009. Experience from crises are quickly forgotten and the opportunity to support the public to take control of their health is an innovation lost.

Health in the 19th century was defined by public health improvements, the 20th century by advances in chemotherapies to treat diseases that caused disability and premature death, the 21st century must be one where health is not bureaucratic but is defined by equalitarianism. That can only be achieved if systems are open to learning from each other.