Must I pay for a complete check-up? How can I have a healthier 2006?

Q. We often hear reports from the medical profession that many diseases might not be lethal if diagnosed early enough. I saw a notice in my local surgery offering complete medical check-ups at a reasonable price. When I applied, I was told that the check-ups were only available for insurance purposes. As a man who is nearing 80, I feel that an examination would be useful, but the cheapest one I can find costs about £350 at Bupa. Do you have any suggestions?

A. Routine medical check-ups sound like an attractive idea, but they have never caught on in the UK. This may be because the National Health Service is really a national disease service. But it is also because there is very little hard evidence to prove that routine check-ups are a useful way of preventing disease and death. Although prevention is definitely better than cure, it is important to remember that routine health checks rarely prevent illness, but they may detect it before it has done too much damage.

In the United States, routine "physicals" are considered to be part of standard medical care. Cynics and sceptics say that annual check-ups are simply another way of lining the pockets of the doctors who perform them. For a man over the age of 65, the US Preventive Services Task Force recommends an annual check of weight and blood pressure, and a physical examination to look for signs of cancer of the skin, thyroid gland, lymph nodes, prostate gland and rectum. It also suggests an annual stool sample to look for signs of blood, which may be an early sign of bowel cancer. Every one to three years, the Americans also recommend a blood test to look for anaemia, raised cholesterol and diabetes, together with hearing and vision checks and a urine test.

Every five years, they recommend a bowel investigation (called a sigmoidoscopy or colonoscopy) to screen for colon cancer.

If you are nearly 80, I think the most important of these tests are the simplest ones - an annual check of your weight and blood pressure. You might be able to persuade your GP to do a urine test for diabetes and a stool test to look for blood, as a screening test for bowel cancer. Most of what you would get at a Bupa Health Assessment (£415 for men of your age) is of unproven benefit. From 2006, the NHS is rolling out a two-yearly national bowel-screening programme for men and women between the ages of 60-69.


Q. Yet again, I am making my New Year's resolutions for healthy living. What are your top tips for 2006?

A. I'm sorry to disappoint readers who are looking for new and different ways to stay healthy, but the top tips for 2006 are pretty much the same as they were for 2005 and 2004, and even 1992.

There are four key healthy-living targets that you should aim to achieve. If you manage to achieve all four, you can reduce your risk of heart disease, diabetes and even cancer substantially. Here they are: don't smoke, have a healthy weight (body mass index between 18 and 25), eat five or more portions of fruit and vegetables every day, and exercise for 30 minutes a day at least five times a week. Although it sounds very simple, a recent survey has shown that only about three in 100 adults reach all four targets. But don't despair. Even if you only meet two or three of the targets, you are still achieving quite a lot.

To calculate your body mass index, take your weight in kilograms and divide it by your height in metres squared (or do it online at Research shows that more men are overweight than women, and men eat less fruit and vegetables than women. Women smoke less, but men are better at exercising regularly.

Have a happy and healthy 2006.

Have your say: Readers write

Advice for people travelling to India with young children, from AF of London:

The sun in India is intense, even in the winter. Take plenty of high-protection factor sun cream, and use it several times a day. Our three-year-old got badly burned on one arm and one leg when he fell asleep on the balcony.

Send your questions and suggestions to A Question of Health, 'The Independent' 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or e-mail

Dr Kavalier regrets that he is unable to respond personally to questions