Preventive Health Basics: Check-ups, Screenings and Vaccines Explained

Most of us think of healthcare as something that happens when we are unwell. Preventive healthcare is the other kind: the appointments, tests and vaccinations offered to people who feel perfectly fine.

It is easy to put off, precisely because nothing is wrong. This guide explains what preventive care involves and why it is offered, so that the next invitation makes more sense. It cannot tell you which checks you personally need. That depends on your circumstances and on where you live, and the last section explains how to find out.

What preventive care means

Preventive care falls into three broad groups.

Preventing illness in the first place. Vaccination is the clearest example. So is advice on stopping smoking, eating well and staying active.

Finding problems early. Screening tests look for signs of a condition before it causes symptoms, when it is usually easier to treat. Routine measurements such as blood pressure belong here too.

Keeping existing conditions under control. Regular reviews for people with long-term conditions help to prevent complications.

This guide concentrates on the first two.

How screening works

Screening means testing people who have no symptoms, to find those at higher risk of a particular condition. It is different from the tests a doctor orders when you report a problem.

Three things about screening are worth understanding.

It sorts people into groups; it does not usually diagnose. A screening result typically tells you whether you are at low or higher risk. People in the higher-risk group are offered further tests to find out what, if anything, is going on.

No screening test is perfect. Some people will be told they may have a problem when they do not, which causes worry and leads to further tests. A small number will be reassured when something has in fact been missed. The NHS is open about this, and it is the reason why screening is a choice, not an obligation.

It is offered only where it does more good than harm. National programmes are set up only after expert bodies have weighed the benefits against the harms for a particular group of people. That is why screening is offered at certain ages and intervals, and why "more testing" is not automatically better.

What is commonly offered to adults

Programmes differ between countries, but several kinds of check appear in most of them:

• Blood pressure. High blood pressure rarely causes symptoms, so measurement is the only way to find it.
• Cholesterol and blood sugar. Often checked together as part of an assessment of heart and circulation risk.
• Cervical screening. Offered to women and people with a cervix across a set age range.
• Breast screening. Offered at regular intervals from middle age.
• Bowel cancer screening. Offered to adults from middle age, often using a kit that is completed at home.

Other checks, for example for abdominal aortic aneurysm, lung cancer or diabetic eye disease, are offered to specific groups in some countries. Eye tests and dental check-ups are also preventive care, though they usually sit outside national screening programmes.

The ages at which each test starts and stops, and how often it is repeated, vary from one country to another. Use your own health service's guidance and not a general list.

Health checks

Some health systems offer a general check-up at set ages. In England, the NHS Health Check is a free assessment for people aged 40 to 74 who do not already have certain conditions, such as heart disease, diabetes or high blood pressure. Those who are eligible should be invited every five years.

The check looks at your risk of heart disease, stroke, kidney disease and diabetes, and includes a conversation about how to reduce that risk. People with an existing condition are monitored through regular reviews instead.

In the United States, an independent panel called the US Preventive Services Task Force reviews the evidence for preventive services and grades them. Services given an A or B grade are those it recommends, and its list is public.

Vaccination does not end in childhood

Vaccines train your immune system to recognise an infection before you meet it. The World Health Organization describes immunisation as one of the most successful and cost-effective public-health measures there is.

Adults are often surprised to learn that vaccination continues throughout life. Depending on your age, health and country, you may be offered:

• a seasonal flu vaccine;
• vaccines offered in later life, such as those against shingles and pneumococcal disease;
• boosters for vaccines you had as a child;
• vaccines during pregnancy, which also protect the newborn baby;
• travel vaccines before visiting certain parts of the world.

If you are unsure what you have had, your doctor's surgery or national vaccination record can usually tell you. Missing a dose earlier in life can often be put right.

How to find out what applies to you

1. Start with your national health service. The NHS in the United Kingdom, the CDC and the US Preventive Services Task Force in the United States, and the health departments of Canada and Australia all publish what is offered and to whom.
2. Make sure you are registered and your details are current. Invitations are usually sent by post, text or email. An out-of-date address is one of the commonest reasons people miss them.
3. Know your family history. If close relatives have had heart disease, diabetes or certain cancers, particularly at a young age, tell your doctor. You may be offered checks earlier or more often.
4. Ask. A doctor, practice nurse or pharmacist can tell you which checks and vaccines you are due.

Getting ready for an appointment

A little preparation makes a check-up more useful:

• note any medicines and supplements you take;
• write down questions beforehand, so you do not forget them;
• ask what a test is looking for, what the possible results mean, and what happens next in each case;
• if you feel anxious about a procedure, say so. Staff are used to this and can explain what is involved.

What you can do in between

Check-ups work alongside everyday habits; they do not replace them. Not smoking, staying active, eating well, limiting alcohol and sleeping enough all lower the risk of the conditions that screening looks for. Everyday habits for better wellbeing is a practical place to start.

Prevention is rarely dramatic. Its successes are the things that never happen, which makes it easy to neglect and well worth doing.