By Matt Smith

THE NHS will be 70 on Thursday, a milestone that has inspired numerous commemorations and reflections, not least Professor Sally Sheard’s exhaustive 20-part series on Radio 4, National Health Stories.

As a septuagenarian, the NHS is showing its age, creaking under the strain of waiting lists, weary as yet another scandal undermines trust and unsure about its future in the public sector as costs sky rocket.

Perhaps we are being unfair to our elderly health service. What about people born in 1948? What sort of health do we expect of a 70-year-old in 2018? And how should this inform the way we adapt the NHS so it can survive for the next 70 years?

In Glasgow, 70-years-old is relative when it comes to health. If you live in Bearsden, Giffnock or Lenzie, 70 is the new 60 or – if you’re lucky – the new 50. You’re likely to be fit, still strolling the golf course or bagging Munros, perhaps even taking on a marathon or a stage of the Tour de France. Why not? You’re likely to push 80 or more if you’re a woman. Seventy is really just another number.

If you’re from Drumchapel, Castlemilk or Calton, it’s a different story. You’ll have been lucky to have made 70, especially if you’re male. If you have, chances are that your age in terms of quality-adjusted life years (a clunky way of saying the years during which you’ve avoided chronic illness) is much lower. You’ll probably have been coping with diabetes, obesity, mental health problems or even cancer or cardiovascular troubles.

These health outcome discrepancies are often discussed in reference to the Glasgow Effect, which posits that the dear green place is somehow hazardous to one’s health. The truth is far less of a mystery. If the history of health and medicine tell us anything, it’s that poverty – and the hopelessness, disenfranchisement, violence and substance abuse that come with it – is bad for health pretty much everywhere. The topsy-turvy nature of Glasgow’s economy during the last century has exacerbated this truth but it’s universally applicable nonetheless.

The best way to resolve such health discrepancies is by preventing the onset of these chronic diseases; that means tackling poverty in a flying, studs-up, two-footed manner that would result in a shower of red cards.

Sir Harry Burns, former Chief Medical Officer in Scotland and at present professor at the University of Strathclyde, has suggested that one way of doing so might be to introduce a universal basic income.

Regardless of the measures taken, the more poverty can be reduced, the better health outcomes will be.

This brings me back to the state of the NHS at 70. In 1948, it was the way the post-war Labour government sought to tackle disease, one of William Beveridge’s five “giant evils”.

The way the NHS evolved to cut this evil down to size was through treatment of disease rather than its prevention.

Given the marvellous pharmacological, surgical and diagnostic developments that have evolved since 1948, it may seem churlish to question such an approach. But, to use a tired yet relevant cliche, an ounce of prevention is worth a pound of cure.

As our population ages (in most places), as new treatments emerge and expectations of the NHS escalate, our disregard of prevention has come at the cost of many pounds indeed, to the point that we may have to pay more taxes (God forbid) to keep the health service afloat.

If we want our NHS to make it to 80, or perhaps even 100, we need to face and eliminate once and for all another of Beveridge’s “giant evils”: want.

Matt Smith is Professor in the School of Humanities at the University of Strathclyde.