Why the Health Action Research Group is needed 

We all know the problems people are experiencing getting medical diagnosis and treatment, including: 

• Over 7 million people waiting for operations
• Longer waiting times for an ambulance, a GP appointment and in A&E
• Almost 9 in 10 NHS dental practices not taking new NHS patients 

That’s why so many politicians, pundits and people are focused on what to do about the NHS. 

However, at the Health Action Research Group we believe there’s a need to dig deeper, including asking why demand for medical treatment is rising: 

• Faster than doctors and nurses can be recruited and retained
• Faster than new hospital beds can be provided
• Faster than social care can be arranged to avoid ‘bed blocking’ in hospitals 

This escalating level of medical need is at the root of many of the NHS’s current problems. That’s why we are focused on what can be done to prevent health problems arising in the first place – why we believe prevention is truly better than cure. 

That’s why we also look beyond purely medical factors, for example to explore why Britain has moved from being one of the most equal nations in Europe in the 1970’s to being one of the most unequal in the 2020’s - and the knock-on effects of this on the nation’s health. 

The government has airbrushed ‘health inequalities’ out of its vocabulary, replaced by the blander ‘health disparities.’ However, it is these very health inequalities (alongside a reluctance to tackle the businesses which mass produce products that increase health risks – from ‘junk food’ to gambling) which have fuelled this escalation in health needs. 

The Impact of Health Inequalities 

1. More than twice as many working age adults died from Covid-19 in the poorest areas of England compared with people living in the richest areas.

2. Even before Covid, the North/South divide in the nation's health was wider than it had been for forty years.

3. 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 these are disproportionally more common in deprived areas, alongside contributing factors such as child poverty.

4. In England today, a person born into a disadvantaged household may only spend 53 years free from a disability, compared to 70 years for people from advantaged households. For example, women in affluent Richmond upon Thames can expect to enjoy an average of 18 years more good health than women in Tower Hamlets.

5. People on low incomes are also often more likely to be employed in working environments or on working conditions that increase health risks. For example, they are more likely to be doing night shifts, which is known to increase health risks.

6. Professor Sir Michael Marmot concluded that social inequality (status) is even more damaging to our health than poverty. The experience of low status and inequality – being low status, feeling low status and being made to feel low status – has a significant and detrimental effect on people’s lives and their physical and mental health.

7. The 2014 Health Survey of England found that 17% of the poorest women took antidepressants compared with 7% of the richest. 

8. We now have the highest obesity rate of any major country in Europe – with obesity rates twice as high in deprived areas. As well as the already known health risks arising from obesity (from diabetes to dementia), during the COVID pandemic people who were obese were more likely to end up in hospital, require intensive care, and die.

9. The Food Foundation reports the UK is unusual within Europe in that unhealthy food choices are often cheaper. Meanwhile, there’s a shortage of affordable housing, with the cost of a home for the lowest earners having risen faster in Britain than anywhere in western Europe. With basics like heathy food and decent accommodation often more expensive in the UK it isn’t surprising that those on low incomes are struggling.

10. More years spent in poor health due to health inequalities means lower productivity and lower tax revenue – and higher NHS, welfare and social care expenditure. 

Fresh, evidence-based research 

At the Health Action Research Group we research major health issues, from childhood obesity to healthy ageing, from the reported mental health crisis among children and young people to health at work. We then explore each issue from as many perspectives as possible to see where the evidence leads us. We also research ‘what works’ in tackling these health issues, including in other countries, to identify approaches which could potentially be adopted or adapted here in the UK. This often enables us to provide fresh perspectives to policy-makers. Here are some examples: 

Our research into the fast-food industry identified that the government was unwittingly subsidising low paid employment in an industry whose products increased health risks. This is because a number of fast-food companies were already known to pursue strategies to minimise corporation tax liability. However, what was not so often realised was that by employing people on a low paid, part time basis this meant they were often under the threshold at which both employer and employee National Insurance payments were payable (thereby minimising potential tax revenue to the government). However, because the employees were low-paid, they were then potentially eligible for means tested State Benefits – i.e. the government was effectively subsidising low paid employment in an industry whose products increased health risks.

 

Early in the COVID pandemic, we noticed that the most vulnerable groups were members of ethnic minorities, people in care homes, and people who were obese – and that one thing this disparate group of people had in common was an increased risk of Vitamin D deficiency. In May 2020 we therefore recommended making Vitamin D available to at-risk groups. Our initial assessment was confirmed by later studies. For example, in January 2021 a review of published studies concluded that prescribing vitamin D to patients with COVID-19 infection seemed to decrease the severity of the disease and the mortality rate, while in May 2021 a UK Biobank study concluded, 'the habitual use of vitamin D supplements was significantly associated with a 34% lower risk of COVID-19 infection.'

  

Our research into ‘what works’ in reducing childhood obesity led us to successful initiatives in other countries, including EPODE (Ensemble Prévenons l'Obésité Des Enfants) in French towns, JOGG (Jongeren op Gezond Gewicht) in Dutch cities and TCOCT (The Children’s Obesity Clinic Treatment) in a Danish hospital. We identified what these initiatives had in common, including the very helpful capacity for scaling up, and shared this information with the House of Commons Health and Social Care Committee, which cited our evidence in its 2018 Childhood Obesity report. Earlier we had been able to help the Department for Health obesity team recognise that, while ‘Calories in, Calories out’ had value as a memorable sound bite, research showed that food (how much and what kind) was a more important factor than exercise when seeking to tackle obesity. This was an important point, as some fast food and sugary drinks companies had been focusing public attention on exercise, thereby diverting attention from the potentially harmful effects of their products.

 

You may have read about the social determinants of health. Our research confirms the significant influence of socio-economic factors on people’s health – as illustrated by the extent of health inequalities in the UK. However, our research also suggests that ‘determinants’ can suggest too fatalistic an assessment. People have agency. There are sometimes choices they themselves can make to reduce the risk of illness. That’s why we have also researched health behaviour change. This included a research project where we interviewed over a thousand adults. The interviews identified ‘trigger points’ when people are more open to listening to and acting on health advice - in particular when they are pregnant, when they have children, when they or someone close to them has been diagnosed with an illness, or as they get older. We also researched student health behaviour change in partnership with King’s College London and Goldsmith’s, University of London. This encouragingly identified that students today (Generation Z) are tending to adopt healthier lifestyles than their predecessors – the first published research in the UK to identify this trend. Interestingly, shortly after our research, the Office for National Statistics (ONS) confirmed that 16 – 24 year olds were the age group pursuing the healthiest lifestyles, in line with our research findings.

 

 

To find out more contact us at info@healthactionresearch.org.uk

 

  

 Health Action Research Group is a not for profit limited company - number 10753014, recognised as a charity by HMRC 

Health Action Research Group, Dalton House, 60 Windsor Avenue, London, SW19 2RR

www.healthactionresearch.org.uk                    info@healthactionresearch.org.uk