Building the evidence around the social and economic value of health

Our latest quick guide What makes us healthy? An introduction to the social determinants of health highlights eight social and economic factors that influence people’s opportunities for good wellbeing and health and the wide range of sectors that need to take action to improve people’s health and reduce inequalities. 

Yet, when health outcomes are still commonly regarded as the responsibility of health care services, how do we motivate the wider action and investment that is necessary to improve and maintain good health? Our new Social and Economic Value of Health research programme aims to build some of the evidence needed to engage and motivate cross-sector action.

The chicken and the egg

We know a lot about the impact of the social and economic determinants on people’s health (indicated by the outline arrow in the diagram below). However, the relationships are complex and dynamic, and little is understood about the other direction: the impact of people’s health on the economy and society (the solid arrow). While there is ample focus on the burden of illness – what ill health costs us both as individuals and as a society – there is rarely acknowledgement of the converse: that good health is an asset, essential for a flourishing society and economy.

While this diagram is an extreme simplification, it illustrates the potential to establish virtuous cycles of improvement in health and in social and economic prosperity, as well as vicious cycles that can perpetuate health and socio-economic inequalities if we fail to invest in improving and maintaining good health through action on the social determinants.  

For example, good wellbeing and health through childhood can support an individual’s attendance at school, and better educational attainment. This can then help them to get into good employment, which we know is a positive influence on health. Continued good health can support ongoing labour market participation and earnings, which in turn provides increased opportunity to maximise their health potential – for example by affording good housing in a safe area, that provides opportunities to be active and consume a healthy diet. And so the cycle continues…

The complexity of this relationship between health status and socio-economic factors is a reason for our lack of understanding of the impact people’s health has on society and the economy. When things influence each other in this way, it is difficult to establish what is causing what (a bit like the chicken and the egg), or where changes in both are simultaneous results of something else entirely. 

An individual’s health status and their social and economic outcomes

As part of our work to help us understand the impact of people’s health on society and the economy our new Social and Economic Value of Health research programme will take a close look at the relationship between health status and socio-economic factors, and try to establish the causal impact of a person’s health. We have awarded six projects funding for up to three years  to help build evidence and understanding about the contribution that individuals’ health status makes to their social and economic outcomes, as well as those of their close family members. 

Their findings will help develop a clearer rationale for action on the social determinants of health, that is consistent with the maintenance of good health throughout people’s lives, and equitably across the population. 

Across the six research projects, the causal impact of both physical and mental health status on a wide range of outcomes will be explored – both throughout people’s lives and across generations. The impact of health on the social factors that are so important in people’s lives – such as the ability to form good relationships – will receive equal focus to the economic outcomes in the research programme as a whole. 

Using recent developments in analytical and statistical methods plus the richness of the data to be used in these research projects, means the research projects can begin to establish causal impacts of health – separating the two halves of the cycle – to clearly understand the effect of health status on social and economic outcomes. Four of the projects use the growing availability and understanding of genetic information to strengthen the establishment of causality (known as Mendelian randomisation methods). This ability to infer causality means that the research will contribute greatly to our understanding of the complex, multidirectional relationships at play between health and socio-economic factors. 

The value of health in a place

This research forms part of a broader programme of work underway at the Health Foundation. We are also interested in the contribution that the overall level and the distribution of wellbeing and health among the population in a geographical area makes to the social and economic prosperity of that place. We will explore questions including: 

• Is (and if so, why is) health – as measured in some way at an area-level – different from the sum of individuals’ health in that place? 
• How does the dynamic relationship between health and socio-economic factors operate in a place? (For example, the interaction between the availability of a healthy labour force in an area and the availability of employment opportunities in that same area.) 
• How could research help us to understand the social and economic value of health at in a place? 
• What answers would be of interest and relevance to policy makers?

Look out for more on this topic from us later in the year as we start to grapple with some of these questions, together with a broad group of experts from academia, policy and practice.

The health and wealth of a community

Our newsletter this month explores all these themes and more, exploring how good health is so essential if individuals, society and the economy are to thrive. In her blog introducing the Health Foundation’s recently published quick guide on the social determinants of health, Natalie Lovell talks about how important it is for everyone to understand how much good health is an asset. ‘Whether your cause is social justice or economic development, or you’re interested in social cohesion, good health is a relevant piece of the puzzle,’ she says. 

Jo Bibby’s blog introduces the latest in our series of infographics on the social determinants of health, exploring how those relationships with the people closest to us are both influenced by our wellbeing and health, and also provide the foundations necessary for a healthy life. This is also summed up in the way that Barbara Nettleton talks about the work of Sunshine House Community Centre in Wigan. Their person-centred approach to supporting local people prioritises pride and dignity and is boosting the health of individuals and the whole community. 

Louise Marshall (@louisemarsha11) is Senior Economics Fellow at the Health Foundation