WHAT SHOULD GOVERNMENT DO TO MEET THE NATION'S GROWING HEALTH NEEDS

The UK has an ageing population. The NHS is struggling to cope with the post COVID backlog. And the current government appears reluctant to tackle the underlying inequalities which are driving the increase in preventable illness, even seeking to airbrush away the term 'health inequalities.' So, it is hardly surprising that health needs in the UK are continuing to grow, with serious implications for people, the economy, the NHS and the government.

What COULD the government do if it really wanted to tackle these health needs? Here are some suggestions:     

1. Ensure all government departments recognise that what is good for the nation’s health is usually also good for the UK economy. 

• Even before COVID, the UK economy was losing almost £92 billion p.a. as a result of ill-health related absence and presenteeism in the workplace.
• More years spent in poor health means lower productivity and lower tax revenue – and higher NHS, welfare and social care expenditure.
• During COVID, the countries which prioritised health usually experienced the least damage to their economies, while looking ahead McKinsey identify prioritising health as a prescription for prosperity.

2. Ensure each government department recognises how it can help address the nation's health needs

The Department of Health and Social Care doesn’t have a remit to tackle the underlying causes of poor health. For example, it doesn’t have any powers when it comes to the production, advertising, pricing and availability of products which increase health risks, such as tobacco, alcohol, ‘junk food’ and gambling. It doesn’t have a remit to tackle pollution; it doesn’t have a remit to raise people’s educational attainment (which is strongly associated with better adult health); it can’t provide people with good quality, affordable housing; it can’t ensure reliable, affordable public transport; and it can’t top up the household incomes of the unemployed or those surviving on insecure, low paid employment. These, and other underlying causes of poor health, fall more within the remit of other government departments. 

3. Ensure Health in all Policies

One simple, low-cost way of achieving this is through the government’s existing Regulatory Impact Assessment required for proposed legislation. This already includes an assessment of the impact on international trade and investment and on the environment. Adding an assessment of the impact on health would ensure that every policy proposal, across every government department, would need to be considered from a health perspective. It is a very practical way of ensuring that health and wellbeing move to being at the heart of everything the government does.

4. Tackling the root causes of poor health across government departments

4.1 THE FIRST THOUSAND DAYS OF LIFE

What happens in the first 1000 days of life can have long term mental and physical health implications, with health inequalities evident from birth, due to the economic, environmental and psychosocial conditions children grow up in. Interventions aimed at mothers-to-be and recent mothers are particularly effective, as they control so much of their children’s environment and experiences from the womb into the early years. Also, action to protect children’s health is likely to have more cross-party support than action to protect adult health, which some might characterise as examples of a ‘Nanny State’.

This is an ideal area for different government departments to work together, for example through a First 1000 Days inter-departmental Task Force, including:

EDUCATION: Wide-ranging evidence links lower educational attainment to poorer health in adult life. Yet language development at the age of 2 predicts children’s performance on entry to primary school. So early action is needed to avoid some children starting primary school at a disadvantage and then carrying that educational disadvantage (and knock-on health disadvantage) into their adult lives.

HEALTH & SOCIAL CARE: The brain undergoes particularly significant growth and development in the first two years of life, with implications for longer term mental health. Health professionals are potentially well placed to identify who is most at risk – and to arrange appropriate interventions.

LEVELLING UP, HOUSING & COMMUNITIES: Childhood obesity is a continuing health issue. Once obese children have become obese adults less than 5% will currently achieve and maintain a healthy weight. Holistic ‘whole system’ community based approaches have proved effective in beginning to reduce childhood obesity, for example through the HENRY programme in Leeds, the EPODE programme in French towns and the JOGG programme in Dutch cities.

4.2 THE NATIONAL FOOD STRATEGY

The National Food Strategy (the independent review commissioned by the government) has identified action needed by the food industry, schools, communities and farmers. It therefore requires action by a range of different government departments, for example to extend eligibility (and funding) for free school meals – and we suggest this as a priority in primary schools. The strategy has been identified. What is needed is the political will and cross departmental cooperation to implement it.

5. How other government departments can help meet the nation’s health needs

5.1 BUSINESS, ENERGY & INDUSTRIAL STRATEGY: for example by action to encourage health at work, where research suggests this is usually a win-win for employee health and business performance e.g. through fewer staff off sick, lower staff turnover, greater staff engagement and higher productivity.

5.2 DIGITAL, CULTURE, SPORT & MEDIA: All four aspects of this department’s work have potential health implications, from the positive and negative effects of social media on mental health to the positive physical and mental health benefits of physical activity. Including health in the Regulatory Impact Assessments for new legislation is likely to be particularly helpful in this department.

5.3 TRANSPORT: Transport has an important role to play in improving health and wellbeing, including the positive health impacts of active travel, ensuring health services are accessible, and the need to limit the damaging effects on health of transport noise and vehicle pollution.

5.4 WORK & PENSIONS: The health implications of this department’s work range from the impact of its policies on people with disabilities and health problems to the implications if future generations face the prospect of years of retirement in poor physical, mental and financial health.

6. Fact checking business lobbyists

Lobbyists from the tobacco, alcohol, polluting fossil fuel and food and drinks industries have had considerable success in delaying government action to improve health over the years, including by presenting misleading ‘research’ findings. The BBC2 documentary Big Oil vs The World provided a number of examples.

A small government fact-checking team could make a useful contribution to identifying where business lobbying across different government departments is evidence-based and should be listened to, and where it isn’t and therefore shouldn’t be influencing government policy.

7. Helping build a stronger, more united and healthier country 

We know that an unhealthy diet, lack of physical activity, smoking, alcohol misuse, low educational attainment, poor housing, insecure employment and pollution significantly increase the risk of poor health – and that these are disproportionally more common in deprived areas, alongside contributing factors such as child poverty. They help explain the health inequalities which are so marked in the UK – and such an obstacle to building a stronger, more united and healthier country. The current cost of living crisis is also potentially tipping many of the previously ‘just about managing’ into deprivation. 

Deprivation and the feelings of stress and hopelessness this can induce are an important part of the problem, for example with people in deprived areas more likely to see smoking, alcohol and comfort eating as ways of managing the resultant stress (and more than twice as likely to take anti-depressants). This deprivation is the result of social and economic trends over many years (including the large scale deindustrialisation in former manufacturing towns). Given the scale of the problem any solution needs to be equally large-scale.

Leveraging the expertise and resources of businesses, charities and community organisations (and strengthening community capacity building) to support cross departmental working would enable more to be achieved – increasing the chances of successful delivery at a local level across the UK, and helping build a stronger, more united and healthier country.

Michael Baber, October 2022