Each of the election manifestos paints a vision of a better society, but viewed through the lens of the social determinants of health (the factors that are the root causes of ill health), they make less sense. If a health service treats a child for asthma, but the same state that provides the NHS then sends that same child back to a damp home in a high crime neighbourhood with limited green space, polluted roads and cheap junk food outlets lining the streets, is that state meeting the needs of its citizens?

The NHS and social care are rightfully fundamental parts of the general election debate, and improving quality and access to health and social care has never been more important. But if we want people to have healthier lives, we need to step beyond the clinical paradigm and broaden our perspective of how we create health and wellbeing. What about the other public policies that will have an influence on health? After all, we only have to look at the US to know that spending more on health care doesn’t necessarily mean better health. In the UK, the Health Foundation has been working with partners to try to change the conversation from health being viewed simply as an output of the NHS, towards health viewed as a social and economic asset – one that can help us all lead flourishing and prosperous lives.

Any rays of hope in the manifestos?

At the Health Foundation, we are thinking about how policy can be used to create health, and a necessary first step is the recognition that all policy has health impacts. Looked at through this lens, examples of health promoting policies from last week’s manifestos might include:

  • The costings of Labour’s increasing tax and ‘borrow to invest’ approaches are rightfully being scrutinised heavily by the media and public. However, policies such as scrapping university tuition fees and restoring maintenance grants for university students could go a long way to helping those from more disadvantaged backgrounds afford higher education. The evidence linking education (at all stages of life) and better health is clear, yet spending on further education is at a similar level to what it was 30 years ago.
  • The Liberal Democrat focus on young people might be music to some of the ears attuned to the social determinants agenda. Bad housing (including insecurity and temporary accommodation) can lead to health problems such as anxiety, depression and respiratory conditions. Pledges like the restoration of housing benefit for 18-21 year olds are more closely related to health than many might imagine. Investing in young people seems crucial at a time when in the Youth Index 2017, almost a fifth say they do not have the ability to change their circumstances if they want to, with devastating impacts on their wellbeing.
  • Recent strikes by cleaners at the London School of Economics over their terms and conditions shines a light on a crucial social determinant of health: work, and working conditions. The Conservative manifesto nods to the importance of good work conditions through a pledge to protect people working in the ‘gig’ economy, a sector characterised by short term contracts. That’s important because these kinds of jobs are often linked to job insecurity and work stress: factors which have been shown to lead to illnesses such as cardiovascular disease and cause-specific mortality.

What would an ideal manifesto look like, if we broadened our perspective of health and wellbeing?

It’s hardly surprising that there’s not enough focus on the potential of social policies to create health and wellbeing in the 2017 General Election. Successive governments have failed to address the social determinants of health, and therefore health inequalities since the 1930’s. (It’s worth noting that the UK is one of the most unequal of the advanced economies: the incomes of the richest 10% of UK households are on average, 11 times higher than those of the poorest 10%.)

Creating health and wellbeing through policy isn’t impossible. It’s already happening at a local level in England, where local authorities are working towards taking action on the social determinants and tackling health inequalities. In Wales, the Well-Being of Future Generations Act 2015 requires public sector bodies to incorporate long term, sustainable wellbeing goals into their work. NHS Health Scotland’s 2012-17 strategy departs from traditional ‘behavioural’ approaches to health improvement and focuses on how to improve health equitably, reflecting Scotland’s social justice agenda going forward. In New Zealand, the government is considering the long term cost of social issues to the state, and is using cost-benefit analysis and other sources of data to identify particular populations at risk in order to design effective services.

That’s not to say that all this is easy. There’s a solid evidence base for the importance of the social determinants of health, but research on the impact of public health interventions often doesn’t take into consideration the complex-systems context they’re operating in. It’s also often difficult to measure the benefits of these interventions. Research funding needs to adapt to generate robust evidence to support system level action.

By the next election, we need to see more political focus on health creating policies such as those outlined above. As Professor Johan Mackenbach once said, ‘Human health and disease are the embodiment of the successes and failures of society as a whole and the only way to improve health and reduce disease is by changing society by, therefore, political action.’

This may take time, and needs to be driven by people’s understanding that health and wellbeing is created by factors much wider than the NHS. But it is certainly a journey worth making. For now though, remember that health isn’t only related to the chapters of these manifestos entitled ‘NHS’.

Natalie Lovell is a Policy Analyst for the Health Foundation.

For more information on policies that support everyone’s opportunities for a healthy life, and some of the examples referenced in the above blog, please read our Healthy Lives Strategy Resources Guide.

Further reading


Miss Chloe Ward BSc (Hons)

Voting Labour, whom are now finally trying to go back to their roots under Jeremy Corbyn's leadership, is the only way to get a political party in that looks after, or tries to - could do so much more though, particularly regarding those with illnesses and disabilities - those at the bottom to bring their living standards and social quality of life and wellbeing. The Conservatives/Tories, also known as and regained this term as the 'nasty party' under David Cameron ruling this country with an iron fist and steel boots, have not generally helped such most vulnerable, voiceless and uncared-about in society-at-large people like the ones that are the most unfortunate from already suffering from illnesses and disabilities, by cutting and removing their much-needed and most likely only source of income of disabiity benefits which they are entitled to - and obviously need - due to their issues and even the UN - United Nations - found out the Tories under David Cameron had created a country, the UK of all places a supposed-developed and civilised as well as rich top 10 nation, that breached disabled people's human rights badly. Such shameful attitudes and behaviour towards the MOST vulnerable and needy group of ALL in the UK. They are also the most discriminated against group too, as employers do not want them due to them being so unwell they may need time off more frequently through no fault or choice of their own or needs special arrangements which can be seen as too costly or too much burden or hassle to implement in their workplace so they have to remain on their disability benefits through no fault of their own even though most do blame them for being 'scroungers' and they NEVER asked to be unwell or disabled - who would? I know most, if not all, would give anything to be as fortunate as their able-bodied and well peers. A life of pain and other horrible things alongside being hated in their alienating community and by even their own Government. Very upsetting. How awful. Seems the Conservatives/Tories have very quickly set the UK on a backwards spiral to regress to the workhouses and forced slavery of workfare and its replacement or equivalent mandatory work placements/experience. I am absolutely infuriated that such a most vulnerable group of people would be treated in such a disgusting manner - work for free or die of starvation, cold, homelessness, etc, if not, as their disability benefits are removed for up to 3 years for the slightest stupid thing like their disability, by its very nature which is why they cannot work, making it hard to get up and get ready so being a little bit late to a jobcentre interview or workfare/experience/placement activities/tasks. They are given no choice and this worsens their already very fragile health, particularly from the constant distress and financial issues. These people, like many on the 'breadline' in supposed civilised and wealthy 'Great Britain', deserve support, not harrassment and punishment and hatred just for being 'different' and not always being able to do paid work that goes into the economy. They still spend all of their disability benefits however on the economy to survive so they do contribute in some way to this, and no doubt most have already paid into the 'system' for their safety net, alongside a lot of informal things they do like supporting others too. This country - UK - and its people are sadly all about and only care mostly about the money and how well the economy is doing. It is pretty much all the Conservative/Tory Government and party go on about, which is why the British people voted them in. However, once these people themselves become unwell or need benefits of any kind for income-related issues they will soon change their minds as they will, hopefully, realise the issues regarding which party really supports them in their great time of need as human beings not monetary objects! I do see and know how the UK still is also not socially physically accessible to those with disabilities, such as wheelchair users many times being unable to go into a shop due to them not having any form of wheelchair access or not being given a seat/place on the bus or train by an able-bodied passenger selfishly taking the disabled area up so having to wait in the rain for another bus, etc. There certainly is much, if not a lot actually, that desperately needs doing to make many everyday aspects of the UK easily accessible and user-friendly whatever disability they may have and the Government could easily do this if it actually cared enough but instead bashes those most in need! Wrong way round that's for sure. The UK is still designed for only able-bodied so-called 'normal' people as seen by no laws or legislation to force shops to be fully accessible to wheelchair users, etc. I know as I had an in-depth discussion with this shop whom was not bothered they were preventing anyone with a wheelchair from obtaining their services or products and they even stated it was not an issue as there is no law or legislation that requires them to cater to this vulnerable group so tells them to go elsewhere in their wheelchair! Obvious discrimination as they are treated unfairly by not having same access to services or products as others. This is Victorian Britain of tomorrow! Nothing much has changed for this group, only very slightly. Even the things like cash machines and vending machines, etc, are too high to reach in a wheelchair so they need help to use it, meaning they cannot be independent, despite the Tory/Conservative Government and their followers constantly going on about how they wish to force them into being 'normal' and independent and working for their economy to plow more profits into big companies from blood, sweat and tears and deterioration of already-poor health! It is stupid and selfish to say the least that only 'perfect', 'normal' and able-bodied people can fully and easily access everything in the UK as they have designed all of it in their 'image' forgetting or ignoring completely those whom are a bit 'different' but are human just like them just with much more challenges and suffering than they will ever know. I do hope Jeremy Corbyn of Labour party helps this completely forgotten-about and most-hated group in the UK at the moment as they badly need it. They have even killed themselves as they feel so helpless and petrified for their non-existent future under the Conservatives/Tories extremely brutal and non-stop disability benefit cuts and have been killed from such cuts too, proven in court via their loved ones, etc. calumslist.org/ is a good website with plenty of relevant and educational information regarding all of this. None is made up - sadly it is true. Even food banks have increased as their use has drastically increased due to benefit cuts for everyone of working age and very poor wages in general for workers whom cannot even afford to eat in UK! A 'developed nation'! Unbelievable indeed. I am here as a strong advocate for the disabled, unwell, poor, working class, homeless, abused and voiceless people and to educate the British public about this as they have no idea a lot of the time - I really hope it is not because they do not care as it could be them one day as disability, illness and financial issues can hit anyone instantly, turning your world upside down and never being the same ever again. We all owe it to ourselves and others to care for our once-only safety net as once it's gone via the Conservatives/Tories it's gone! You will NEVER get it back either! Let's work together for a better tomorrow. A nation certainly is judged by how it treats its most vulnerable members and the UK, proven by the UN Report/Findings, is not doing well at all and should be fully ashamed and reverse all the unnecessary and nasty cuts to such vital benefits. Happy people and workers makes for a pleasant and great country to live in. Less crime, better living conditions, workers' rights fully upheld, full disability access and support, getting along with each other better, good safety net for when times get rough and a true leader of the UK and Government that LISTENS to its people even if they are poor, homeless, disabled and a minority they still should count and be heard fully as much as anyone - so far protests have happened on many things yet the Conservative/Tory Government never seems to listen and take notice - they just forced through for example the £30 a week ESA disability benefit cut. That is a lot of money taken from such an already poor and vulnerable group, without even asking them to vote on it! £30 a week - that is no doubt their food money gone so they can only 'heat or eat' not both, so need the food banks - even the nurses and other workers now have to use food banks as their wages are way too low! UK please get a grip and help your people at home rather than only increasing the Foreign Aid budget! That was the ONLY thing that over all of the David Cameron Conservative/Tory rule of 5, nearly 6 years. Got their priorities all wrong way around and are not for anyone but the 'elite' anyway and very upper-class that never have to work to survive! We need a true leader and party in Government that will invest in our own people and country and not bother with this failed austerity ideology, which has been proven is a poor theory with no strengths/no evidence of working. Our country is still in more debt than when Labour left in 2010! So much for the supposedly trusted Tories/Conservatives under David Cameron improving our UK economy within 5 years as he strongly promised and boasted in his manifesto in 2010 and afterwards and he has hurt so many poor and vulnerable people in their own land, here in the UK! Everyone should be cared about and for and the UK needs to be less money or profit based, particularly as it sees its people as money objects and despises them if they do not or cannot work to make huge profits for already-rich people! Do not fall for it - we need an approach and culture that values all people fully and accepts them, particularly those with disabilities, homeless and poor whom are not liked much by many in UK at the moment from all theTory/Conservative hysteria and rhetoric of scroungers, lazy, burden, work-will-set-you-free (now where have I heard that one before?!) attitude, no such thing as fully disabled so MUST work or die view/treatment, cut disability/working age benefits as burden, etc, etc - very upsetting and heartless, particularly when done by those with so much already. I honestly would love to see a truly caring leader of the UK and a transformed country of which I can then be proud of as right now I am ashamed to say I am English! My people all fought and lost their lives for this country not to be ruled like this so I will encourage everyone to remember that and take it on board, particularly next time you see an individual whom is unfortunate enough to be disabled or unwell or homeless or poor or poor worker. They are human too and want the same things everyone does and not to be bullied or despised just because of one thing that they have 24/7 that causes them already to suffer. Same for homeless - they need our help and compassion. We need a caring approach, not a punishment or 'burden' if cannot make money approach! Society does have a huge impact on people, such as those with disabilities being too afraid now to go out on their own or out at all currently from increased disability hate crime, such as being thrown out of wheelchairs or spat on, etc. There is no need for that kind of behaviour! We need everyone to have equality and fairness with compassion more too, as it is all badly lacking now from everyone pretty much believing Conservative/Tory rhetoric of anyone on benefits being a burden and worthless, etc. Even benefit fraud rate is 0.7% according to official figures, not anywhere near what they would have you believe and were even found out to have made that DWP leaflet thingy with pretend opinions/feedback from fake happy people they made up to look successful workfare/forced unpaid work placements! We need to build more social housing too and shelters for homeless to help them not be stuck out in the weather and becoming unwell or hurt by someone as homeless people get beaten up too by public just for being homeless. Wages need to increase drastically with inflation/prices, etc, same for benefits. Thank you ever so much for reading all of this and I do hope you came away from it with some extra knowledge, awareness and enlightenment as that is my goal. Have a nice day.

























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