New dystopian fiction shines a light on the social and commercial determinants of health

In April 2017, we launched the short story competition Health: From here to where? in partnership with the Royal Society for Public Health.

The competition had an unusual brief – we challenged writers to create a dystopian future in which society had failed to act on the social and commercial determinants of health. We wanted to shine a light on the lack of choice and control young people face on the factors that shape their wellbeing and health.

Tim Byrne’s winning story, What You Want is carefully constructed, engaging and gives us an insight into a future that may not be so far from reality, if we don’t do more to tackle the complex forces that can influence people’s health negatively.

Warning: This blog contains spoilers and refers to the winning story of our competition. If you would like to read the story or listen to it being read by BAFTA-nominated actor Michael Sheen, please visit fromheretowhere.org.

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In the opening scene we meet Jay, a young boy who, throughout the story, is constantly being tempted by a series of interactive, virtual adverts trying desperately to sell him unhealthy snacks. Last August our Director of Strategy, Jo Bibby, wrote about the dangers of heavily marketed, processed foods. The cute virtual dog in Jay’s world pestering him to buy a pack of ‘Fryzzlies’ isn’t exactly the same, but it certainly doesn’t take a huge leap of imagination to juxtapose this virtual, ad-ridden world with our own.

Jay has to contend with these virtual ads (waving little flags saying ‘Buy Now! Buy Now!') in a largely tech-driven world. The rest of his surroundings reveal a number of other challenges in his life:

• a house ridden by damp
• an unsafe neighbourhood with no green space for him to play
• a hard-working father with no choice but to work on the other side of town
• social isolation
• peer pressure
• and not enough money for lunch.

We feel a rising sense of empathy for Jay as he faces these challenges – yet we know that the reality for many young children in the UK is not too dissimilar. For example, we know that access to green space can lead to improved mental health and a higher likelihood of exercising. Yet our world resembles Jay’s in that people living in the most deprived areas are ten times less likely to live in the greenest areas.

Underscoring the constant barriers Jay faces in his life is the concept of inequality. The disadvantages in Jay’s life are not equally distributed. He isn’t protected from the terrifying virtual Tyrannosaurus Rex in the same way Robin, a boy from a wealthier background is. Similarly, Jay’s father hasn’t had the same education or employment opportunities as the people who live in the wealthy streets he cleans.

Despite the notable lack of T-Rex’s, this future resonates jarringly with our own world. A recent report by the IPPR shows us that the UK has the most geographically unequal economy in Europe, and young people are set to be poorer than their parents. These challenges will affect young people’s ability to have control over their lives and achieve their full potential. These factors have been identified by the Marmot Review as key to reducing health inequalities, and improving wellbeing and health.

In the story’s final scenes, Jay’s school (a downtrodden space with few resources) announces its closure – a bleak ending not only to the story itself, but to an institution supposedly symbolic of hope and possibility for young people. This is not an unrealistic portrayal of current UK society, in which only half of young adults believe the education system is adequately preparing them for later life. 

There are various ways in which the Health Foundation is trying to tackle some of the issues identified in Tim Byrne’s winning story.

• Our infographics series is helping to explain what we really mean by the ‘social determinants of health’.
• Our Young People’s Inquiry will support us to understand the opportunities that impact upon young people’s future health prospects.
• We are also funding work on complex systems to enhance our understanding of the population-level interventions that are needed to take on the big health challenges in our society.

We’re also pleased to announce that we’re in the process of brainstorming ways in which the winning story could be developed as a learning resource for schools to help young people think about health differently.

Finally, how do you think we can promote discussion about the factors that influence the public’s health in a creative way? We’re open to suggestions. Please let us know in the comments below.

Natalie Lovell is a Policy Analyst for the Health Foundation