Action by government
The importance of public health for the economy
Governments may not always realise how important good health is for the UK economy. Let’s take three examples:
1. Pre-COVID the UK economy was already losing almost £92 billion a year as a result of ill-health related absence and presenteeism in the workplace. That’s according to research by Vitality in partnership with RAND Europe, the University of Cambridge and Mercer.
2. COVID 19 has had a major impact on the economies of countries which delayed taking preventative action, like the UK and USA. Here in the UK, according to The Financial Times, the economy shrank by a fifth, the largest fall of any of the world’s developed economies. However, countries which acted quickly to protect health were then able to restart their economies more quickly, so experienced a much less serious financial impact. Taiwan, South Korea, Denmark and New Zealand are good examples here.
3. The UK government is currently, unwittingly, subsidising the sale of ‘junk food’ that is driving up obesity and Type 2 Diabetes rates at significant cost to the NHS and thus UK taxpayers. That’s because, as well as being adept at minimising corporation tax payments, fast food companies typically employ large numbers of low paid staff, working part time or on zero hours contracts. The low salaries mean the companies avoid paying employer National Insurance and their workers avoid paying employee National Insurance i.e. lost tax income for the government. However, the low pay means many of their workers are eligible for means tested State Benefits, as the ‘working poor.’ So, the government ends up subsidising the sale of ‘junk food’ and its knock-on effect on NHS expenditure.
Action to improve the nation’s health is therefore likely to have significant financial benefits too.
Preventing future pandemics
Covid-19 is the most serious respiratory disease to affect the world for a hundred years – but it isn’t the first and is unlikely to be the last pandemic challenge the UK will face. So, what public health lessons can the government learn from these outbreaks, to reduce future risks to our health and the economy? Here are our eight recommendations:
1. Be Prepared
Make sure the UK has the capacity to respond, including:
- a stockpile of PPE and contact details of potential UK suppliers
- UK based diagnostic and equipment companies, so we can be more self-sufficient
- Logistic/emergency planning experts (from the military, private sector or disaster relief charities) to ensure policies are deliverable and to oversee successful implementation
- Sufficient trained health professionals. Given recent NHS winter crises they will presumably be a valuable resource for years to come.
2. Take Public Health Seriously
In pandemics people with underlying health conditions are usually most at risk of dying and most likely to require weeks of expensive, time consuming intensive care. With COVID-19 that includes people who are obese. So, we urge governments, businesses and employers to do more to make healthy choices the easy choices for people. If people are healthier this won’t stop pandemic deaths – but it should reduce them and reduce pressure on the NHS.
This also means that the government should be investing in Public Health, as the front line in disease prevention.
3. Respond Quickly
COVID-19 showed that countries which took early action usually experienced fewest deaths and least disruption.
For example, Taiwan was probably the quickest country to respond, taking a range of actions to combat COVID-19, starting as early as 31st December 2019. By April 24th 2020, Taiwan had fewer than 500 cases and only 6 people had died.
4. Control Borders
Pandemics don’t respect national boundaries. International travel by land, air or sea (including cruise ships) can help the rapid spread of pandemics. So, it makes sense to close borders early (and arrange for returning Brits to go into quarantine).
5. Track, Trace and Isolate
This has been an important reason why countries like Taiwan, South Korea, Germany and New Zealand have experienced relatively low death rates. It reduces the number of people each individual can infect, by identifying who is at risk through contact with an infected person and then isolating them for a period of quarantine. Without new human hosts to transmit the disease the spread of the virus is dramatically reduced.
For Track, Trace and Isolate to be a rapid, effective option in the UK we need:
- A UK diagnostic industry, as a strategic priority. One of the reasons Germany could mass test so quickly is that it already had a range of diagnostic companies.
- Contingency Plans for widespread testing, at scale – whether through drive through testing centres, home testing kits or other practical testing arrangements.
- Plans for mass tracing – through professionally trained tracing teams, supported by tracing apps where feasible.
6. Stop Hospitals and Care Homes spreading disease
If doctors, nurses and care home staff don’t have proper PPE they can spread infection, making hospitals and care homes pandemic epicentres. And when they under heavy and continuous pressure, working long hours in demanding conditions, this weakens immune systems and increases vulnerability to infection.
That’s why it is important to Track, Trace and Isolate to slow the spread of infection and reduce the number of people needing hospital treatment, while also, as a contingency plan, ensuring there’s enough PPE for both hospital and care staff.
7. Build and maintain public confidence
This is important if action like nationwide social distancing or the wearing of face masks needs to be introduced and then sustained. Our advice to government is:
- Promise less, deliver more - so you build credibility
- Lead by example - visibly do what you're telling the public to do.
- Ensure you've got the right experts working with you (including logistic experts and experts in the immune system), so you can agree the right policies and then deliver on them.
- Share the advice you're receiving with the public, so they can understand what they are being asked to do and why.
8. Don’t underestimate the importance of face masks
Wearing face masks may help build immunity, by significantly reducing the viral load we are each exposed to. This gives our bodies an opportunity to recognise and fight off the infection, resulting in asymptomatic or mild symptoms – effectively immunising us. It is surely no coincidence that Asian countries with a tradition of mask wearing have had better health and economic outcomes.
Tackling the rise in non-infectious diseases
Prior to COVID-19 the UK health system was already under threat from rising levels of non-communicable diseases due to smoking, excessive alcohol consumption, ‘junk food’, lack of exercise and social inequality. This threat remains and continues to grow – as seen, for example, in rising obesity and Type 2 Diabetes rates.
Successive governments have been wary of taking a ‘Nanny State’ approach – for example by determining what we should eat and drink. However, companies that mass produce or sell ’junk food’ and sugary drinks, that mass produce or sell cigarettes and high strength alcohol, and that create pollution (whether through factories or vehicle exhausts) all increase the risks to health.
So sometimes government needs to take action
In practice, governments can and do legitimately take action when it:
- Is in the public interest
- Protects people who would otherwise be placed at harm’s risk as a result of actions by others
- Ensures the protection of those who can’t protect themselves, like young children
Over the years this has enabled governments to take action in a variety of areas, from banning smoking in workplaces and public spaces, to speed limits and compulsory car seat belts, to banning female circumcision. Whilst some of these measures were controversial at the time their value is now widely accepted.
Having established that government has a potential role to play, here are some examples where action could make a significant contribution to public health:
Child health is particularly important, because what happens to us in the first thousand days of our life (from conception onwards) can have a big impact on our long term mental and physical health prospects. So, government action to help parents help their children make the best start in life is likely to prove particularly effective.
We also know that social inequality leads to health inequality. People in less affluent areas tend to die younger and enjoy fewer years of good health. So, action by government to reduce these inequalities is likely to be good for public health.
Tackling childhood obesity
The first thousand days of life, from conception onwards are particularly important. What happens to us during this time can affect whether or not we are likely to become obese and can also affect our long- term health. It is also much easier to prevent obesity than for people to get back to a healthy weight on a sustained basis once they have become obese.
To tackle childhood obesity we recommend the government:
- Fully implement the proposals in its Childhood Obesity Plans of 2016 and 2018 and take forward the proposals in its 2020 Tackling Obesity policy paper.
- Consider what further action is needed – including what can be learned from initiatives which have successfully reduced levels of childhood obesity in parts of France, the Netherlands, Australia, Denmark and (most recently) Leeds.
Binge drinking doesn’t just harm binge drinkers. It is also responsible for alcohol fuelled violence and anti-social behaviour, drink driving accidents and significant pressure on hospital A&E departments. For example, the Chief Executive of NHS England reports that binge drinking costs at least £5 billion a year – in A&E admissions, road accidents and extra policing.
To reduce binge drinking we recommend the government:
- Agrees targets to reduce alcohol units consumed, for example through lower alcohol drinks or minimum unit pricing
- Agrees independent assessment and verification arrangements
We know that social inequality leads to health inequality. On average people in less affluent areas die younger and enjoy fewer years of good health. There is probably no quick fix here but government action to reduce these inequalities is likely to be good for public health.
One starting point might be the huge pay, pension and benefits divide there often is between those at the bottom and top of organisations – a divide which does not appear to be performance related. For example, a report by research firm Income Data Services found that between 2000 and 2010 the pay of Chief Executives at the 350 largest quoted companies rose by 108% - whereas the value of the 350 companies rose by just 8%.
To begin to reduce social inequality we recommend:
- The remuneration committees of large companies, which decide senior executive pay, to include at least one third staff representatives – to help begin to address the issue of income inequality which underpins social inequality.
Don’t put all your eggs in the apps basket
Providing personalized health information is helpful but we shouldn’t assume this will be enough to change behaviour. In practice, the people who tend to act on this information are those who are already more health conscious. This effectively increases health inequalities. Given the influence of peer pressure on our behaviour, we recommend more focus on community-based approaches, as a more effective means of reducing health inequalities.
In a political environment which tends to view either markets and individual consumer decisions on the one hand or State regulation on the other as the major levers for change, it may be time to add a third dimension i.e. the importance of encouraging active and empowered communities as a catalyst for health behaviour change, as crucial partners if issues like childhood obesity and mental ill health are to be successfully tackled.
- Support for initiatives to help re-energise and activate local communities in deprived areas, as part of the government’s levelling up agenda – working with elected Mayors wherever feasible.
Health at Work
There is also much employers can do to encourage Health at Work (a point the government’s Tackling Obesity policy paper recognised) as a potential win-win for both employers and their employees – meaning fewer sick days lost, enhanced productivity and improved morale.
To encourage healthier behaviour we recommend:
- Incentives for organisations to improve the health of employees. As one in four employees work for an Investors in People (IIP) organisation, one simple step would be to incentivize Investors in People to add a new indicator to their accreditation i.e. supporting the physical and mental health of employees.