If you were to choose a government department you would run for a day to improve the health of the population, which would it be?
You might instinctively choose the Department of Health. But since access to health care accounts for as little as 10% of a population’s health and wellbeing, it is unlikely to be your best choice. Instead, because it is the conditions in which we are born, grow, live, work and age that contribute in large part to our prospects of a healthy life, you might be better off with HM Treasury, the Department for Education, or the Department for Work and Pensions, perhaps.
Yet there is a lot less attention on the policy action needed outside the health sector to create better health and wellbeing by influencing the social determinants of health – for example, our access to adequate income, good education and work, decent homes and strong social relationships.
Learning from other countries
To support better policy making, we want to share how other countries have used social policy to create better health and wellbeing.
We are funding a new study by the UK Health Forum to generate a series of international case studies of national and sub-national policy action beyond the health sector.
They are scanning the literature to identify case studies and conducting in-depth interviews with policy makers, advocacy groups and others close to the policy processes, to help to get ‘under the bonnet’ of the identified policies and their effect on health. We want to reach a better understanding of how the policies were introduced including the policy context, development and adoption processes, enabling factors, and obstacles encountered.
French lessons in sugar taxes
Next year sees the introduction of a soft drinks industry levy in the UK – a measure that was introduced in the 2016 budget and which forms a major pillar of the government’s childhood obesity plan. It is almost 250 years since Adam Smith wrote that sugar, tobacco and rum ‘are commodities which are nowhere necessaries of life’ and ‘therefore extremely proper subjects for taxation’.
The factors that informed the government’s decision to introduce the levy indisputably include the lessons learned from overseas. Since 2011, taxes on sugary drinks and some junk foods have been introduced to promote health and reduce obesity in France, Hungary and Mexico. Evaluation and analysis by researchers and civil society organisations has provided insights from these ‘natural experiments’ to answer important policy questions: How do different tax instruments achieve desired outcomes? How do consumers respond to taxes? What are the effects on consumption of untaxed products and categories? How do businesses react? Do the taxes raise revenues or are the costs absorbed? Are taxes for health unpopular or accepted as a necessary measure? The opportunity to learn from real world experience will have helped Treasury officials design the UK levy so it is likely to achieve the Government’s desired objective of encouraging drinks manufacturers to reduce the sugar content of their products.
Meeting long term challenges with action across government
Learning from international innovative approaches could help start new conversations in other sectors. For example, the Austrian government, as part of its health reform, is engaging six ministries along with federal and provincial authorities working on education, employment, social security and the environment to build their understanding of how they can each contribute towards the delivery of health targets for the Austrian people.
In New Zealand, the treasury has developed ways to meet the challenge of making an impact on long term issues such as health, education and justice while constrained by short term decision making and investment. The New Zealand approach involves assessing public liability for individuals whose circumstances and experiences represent a potential lifetime cost to the state. For example, a child growing up in a troubled family is more likely to fail at school, become unemployed and possibly end up in the justice system. Having calculated the collective cost, the government can task public services to reduce the public liability by investing in services that can be shown to deliver long term benefits.
The study by the UK Health Forum, due to be published in early 2018, will highlight other examples of policies which act on the wider determinants of health, helping us to see where there may be transferable learning for policy makers across our governments that could lead to a healthier UK population.
I was asked to choose my fantasy ministry-for-a-day to improve population health at an interview to join the Health Foundation. I opted for HM Treasury, reasoning that this presented opportunities to invest in public spending across other government departments and make use of fiscal measures like the sugary drinks levy. I may have convinced my interviewer, but the best option might be to take the top job, engage all parts of your government and create a truly health-creating economy.
Jane Landon is Senior Policy Fellow at the Health Foundation, currently on secondment from the UK Health Forum.