A new deal for health? The links between economic infrastructure and health and wellbeing

Last week a job was advertised that could have the greatest impact on population health for the next 50 years. No, you didn’t miss anything; Sally Davies’ job isn’t up for grabs, nor Duncan Selbie’s or Bruce Keogh’s. The job I am talking about is the Chair of the National Infrastructure Commission. The Commission provides the government with impartial, expert advice on all aspects of economic infrastructure: energy, transport, water and sewage, waste, flood defences and digital communications. It will be looking at the key drivers of change, taking a long-term view of up to 30 years.

As the job specification acknowledges, high quality infrastructure not only has economic value but also enhances quality of life. The opportunity to put improvements in quality of life (which, for the vast majority of us, means our health and wellbeing) at the centre of decisions about our infrastructure strategy gives this role huge potential.

In the 1930s, the US embarked on a national infrastructure programme, Roosevelt’s New Deal. David Stuckler’s 2013 book The Body Economic shows that this initiative was, in effect, the biggest public health programme ever to be implemented in the US. First because it put people into work – 8.5 million jobless Americans worked on the new construction projects – and, as has been repeatedly shown, poverty and unemployment are among the greatest risk factors when it comes to our health. Second, because the work created through the New Deal was ‘good’ work, supported by wider social schemes such as making home-ownership affordable.

While we are in a very different place from 1930s America, Britain needs its own New Deal for Health. The Chair of the National Infrastructure Commission could genuinely transform people’s quality of life and life chances by putting the following considerations at the centre of their work.

The current disparity in infrastructure across the UK is a barrier to inclusive growth strategies and is at the heart of the health inequity. The Marmot Review found that an infrastructure that facilitates opportunities for good jobs more evenly across the country will have a profound effect on health and wellbeing now and for future generations. So perhaps it’s not surprising that when we are currently spending £1,900 per head a year in London on transport infrastructure compared to £300 in the north east, we also see large differences in life expectancies. As ONS data shows, people born in the south east of England between 2012 and 2014 can expect to enjoy – on average – 6 more years of good health than those born in the north east.

As well as the benefits that will come from simply levelling up the quality of the infrastructure in this country, investing in infrastructure can have a positive impact on health in its own right. First through ensuring the quality of the working conditions for those employed: fair contracts, the living wage and high quality apprenticeships are all things that have been shown to enhance people’s health. And second, through the types of developments that are supported. For example:

• Transport infrastructure across the UK fails to meet the requirements of an active transportation system. Active transport can reduce the risks of air pollution and support people to engage in more walking and cycling. 
• Decisions about our future energy requirements must be considered alongside reducing demand for energy through better insulated homes and workplaces. This has significant potential to improve people’s living environment and, with it, long-term health.
• Action to expand transport and digital infrastructure can also support the reduction of social isolation, a factor that can be crippling in terms of people’s wellbeing.

Finally, perhaps the most transformative step the Chair could take would be to put ‘human infrastructure’ within scope of the Commission. Our future prosperity clearly depends upon us having a modern infrastructure. But it seems equally self-evident that without a healthy population able to contribute fully to work and community, our infrastructure is moribund.

Although people are living longer, the same improvement has not been seen in healthy life expectancy, meaning that people are spending more of their lives with disease and disability. So it’s crucial to consider investment in people’s long-term health to be as important as the long-term investment we accept as necessary to build transport, energy and digital infrastructure. We are a long way from taking this view as a society. Instead we allow people’s health to be eroded by short-term decisions: cuts to investment in early years, inadequate training opportunities for young people, failure to adequately regulate against the modern public health challenges of sugar, air pollution, and so on.

For the state, this short-termism leads to loss in economic and social output of the population and high costs in welfare and health care spending in later life. For the individual it leads to lives blighted by avoidable illness.

Let’s hope that the appointed Chair sees these opportunities to improve and protect people’s health and frames success not simply in terms of economic growth but also as creating the opportunities to live healthy lives. After all, without our health, our ability to make a contribution is diminished and, with it, our humanity.

Jo Bibby (@JoBibbyTHF) is Director of Strategy at the Health Foundation