Happier days: Vera and Jack in a 1995 episode of the long-running soap opera, Coronation Street. Photo: ITV/Rex Features

Nearly 13 million of us watched Vera Duckworth (actress Liz Dawn) pop her clogs on ITV1's Coronation Street last Friday, after 33 years service on the soap. Vera will be resurrected again on morning television, after the "funeral", when Liz Dawn discusses the lung disease, emphysema, that is the cause of her departure - a disease triggered by smoking all her life.

I watched Vera's end with my mum, 84, also suffering from the consequences of a lifetime of fags - although she puts it down to "a bit of bronchitis" Always fit and energetic, she is now a "pink puffer", unable to find the wind to take the long (or, for that matter, short) walks she once loved.

What response did the trauma and tears of Vera's exit evoke in my mother? A quick trip to the kitchen to light up another ciggie. She is adamant that she's smoked all her life and she isn't going to stop now. Dawn, however, is on a crusade to encourage others not to follow in her footsteps.

Geoff Mulgan, director of the Young Foundation in a speech given three years ago, made some interesting observations about the long-term impact of chronic disease.

In the 19th century, he pointed out, health was focused more on acute diseases - for instance, cholera. In the 21st century, there's a growing awareness of the importance of prevention and a holistic approach to health to help tackle, for example, obesity and depression. Yet chronic diseases still eat into the NHS budget.

Over 45% of the UK's adult population has one or more long-standing illness. Three to five million suffer from asthma, eight to 10 million have arthritis, over a million suffer from diabetes. The NHS spends 80% of its budget on chronic disease, which takes up over 60% of hospital beds. As a result, only 4% of the NHS budget is spent on prevention. (Prevention, of course, is hard to measure and monitor. It also requires a long-term view not much favoured by governments. And, a cynic might suggest that prevention might appear less than healthy in terms of profits for those making a mint out of PFI initiatives.)

Mulgan said:

"A health system shaped by the 19th century problems of contagious and acute diseases is now having to cope with a new epidemic of chronic disease but without very good means of coping ..."

A high proportion of chronic disease is influenced by social circumstances (depression is acerbated by poverty and unemployment) and behaviour - eg the fatter you are, as is well known, the higher the risk of diabetes. So, how do we improve the quality of life, especially for those at the bottom of the economic pyramid (money isn't the only answer but an increase in benefits and a simplification of the system would help)? And how to unearth and disseminate new ideas to help people to cope better with managing their own health, individually and collectively?

Simple changes might have major results. According to research, for instance, a doctor interrupts a patient within 90 seconds of the consultation. Sometimes, all a person needs is someone to hear them out. Twenty minutes per patient doesn't sound too extravagant a "waste" of time.

The NHS now means the National Sickness Service (even more so since the advent of superbugs). If a holistic, preventative approach is what's required to fight off the consequences of too much food, booze, tobacco, drugs, stress, loneliness, isolation and the impact of growing older than something else is required. But what?

The answer has to be more imaginative, varied and wide-ranging (outside the NHS as well as within) than individual willpower - which is anyway much weakened by the 24-hour onslaught of advertising, film and media allied to a sense of despair and futility that appears to plague some of the British in a way not easily matched in much of Europe.

"Good health!" once seemed such a simple salutation. But with almost half the population apparently suffering in the long term, it's more like a bout of wishful thinking.