Services - including those helping people stop smoking - could be cut
The NHS is facing "seven years of famine" because of the economic downturn, whoever wins the next election.
Preventive healthcare is liable to see serious budget cuts - but public health expert Dr Alan Maryon-Davis says in this week's Scrubbing Up health column that this would be "short-sighted folly".
After a decade of record investment, with a tripling of its budget since 1997, the health service is facing "seven years of famine" from April 2011 as the Treasury claws back money to help rebuild the reserves it spent on bailing out the banks.
Even now, with 15 months of the good times still to go, the planners are looking to see where they can make so-called 'efficiency savings' - cuts to you and me.
My worry is that, if history is anything to go by, the first things for the chop will be preventive programmes such as stop smoking services, healthy eating initiatives, physical activity promotion, alcohol education projects, mental health work and safe sex drives.
These are all 'soft targets' for the axe-swingers.
The benefits are in the future and there aren't any immediate shrouds to wave.
The last time there was a raid on NHS budgets in 2006-07, the millions allocated to a national health improvement strategy called Choosing Health were quietly snaffled to prop up the massive overspend on hospital services and medication.
Suddenly, the much-vaunted Choosing Health strategy, with its high hopes of a healthier nation, was dead in the water.
But that financial crisis was a mere hiccup compared to the year-on-year hard times just over the horizon.
This time the 'efficiencies' will be deeper and longer-lasting. The NHS is facing a new ice age.
My plea to the army of health service planners and commissioners is simple; hands off prevention. Find your savings elsewhere.
Precious NHS money is still being wasted.
Too many cases are being inappropriately treated in hospital. Too many people are using A&E instead of a GP. Too many are being sent for unnecessary tests. Too many are prescribed high cost drugs when cheaper ones would do.
We need to spend more money on prevention, not less.
'Adding to the burden'
It is sheer short-sighted folly to cut back the very programmes that can help prevent the chronic conditions like high blood pressure, diabetes, heart disease, strokes, cancers, chronic lung disease and mental illness, that are crippling the health service.
Our ageing population with its greater health needs, the spiralling cost of high-tech hospital diagnosis and treatment, expensive new drugs and long-term care are all adding to the burden the NHS has to bear.
By promoting health and wellbeing, and preventing disease, we can help people stay younger longer, in better physical and mental shape and less dependent on drugs and expensive treatments.
In short, we should be aiming to add life to years rather than simply adding years to life.
The National Institute for Health and Clinical Effectiveness (NICE) has repeatedly shown how cost-effective low-tech preventive programmes such as stopping smoking and promoting exercise can be compared to long-term medication and high-tech diagnosis and treatment.
Only a paltry 1% or so of the NHS budget is currently spent on promoting health - a proportion that has hardly changed in 20 years.
True, rather more is spent on clinical preventive services such as antenatal care, newborn screening, childhood immunisation, cancer checks, contraception, eye tests, oral health and check-ups in general practice.
But even so, the whole prevention slice is tiny compared to the money spent on trying to patch people up after they have already fallen ill.
This is simply unsustainable. We need to move from a 'national illness service' to much more of a 'national health service'.
Politicians of all hues pay lip-service to this mantra. But there's real danger that such good intentions will be steamrollered thinner than an NHS finance director's smile by the impending cuts.
The recession has meant that many people are finding it harder to lead healthy lives and need all the support they can get. Health inequalities continue to widen. Prescriptions for depression are soaring.
We need not only to protect the health promotion and disease prevention services we've got, but actually invest more in them.
And we need to start doing that right now.