Twelve months ago, the Health Foundation set out to explore our contribution to enabling everyone in the UK to live a healthy life. Starting with an international seminar in Salzburg, the year unfolded into a series of thoughtful and stimulating discussions on some of the intractable problems that limit the ability that individuals and society have to maintain and improve wellbeing and health. It quickly became apparent that there was no limit in the scope for action; the challenge was going to be where to focus and where we could apply our expertise to have the most impact.
Our first step has been to build clarity on the approach we will take to bringing about better health for people in the UK and our publication: Healthy lives for people in the UK outlines the principles that will underpin our long-term strategy. Guided by these principles, here are some highlights from our plans for 2017.
First, we want to see a change in the conversation around health. Too much of the public discourse is dominated by ill-health – its impact on the individual, its costs to society and the action needed to mitigate it. While we will always need high-quality health care, this alone will not enable people to live healthy lives. There needs to be more explicit recognition of the factors that shape our long-term health outcomes and the breadth of action needed to maintain and improve health over the life course. Through a range of communication activities, we hope to raise awareness of the wider determinants of health – the factors that shape where we live, learn, work and play – and build an understanding of health as an asset.
With this in mind, this summer we will be issuing a call for research to explore how health is a contributor to economic and social development – as much part of our national infrastructure as transport, digital connection or housing. We know a lot about the economic costs of poor health but less about the economic and social value of good health. A better understanding of this evidence could help policy makers take a longer term, ‘investment’ perspective on building health by tackling wider determinants of health, rather than solely treating illness.
Investing in health is for the long term. Our experiences, behaviours and habits as children shape our long-term health outcomes. And as these experiences, behaviours and habits are shaped by our environment, creating the opportunity for good health needs to be viewed as a population rather than an individual task. This presents a significant challenge to building the evidence needed to support decision making. Established research methods that provide certainty on the effectiveness of individual-level action on short-term outcomes, such as the randomised controlled trial, cannot be applied as easily to upstream, population-level interventions that need to take into account complex systems. During the coming year, we will be developing approaches to meet this challenge.
The types of action that are most likely to impact on our long-term health: education and employment opportunities, housing and the built environment, families and communities, predominantly fall outside the influence of government health departments. In order to promote understanding of how wider government policy making can better influence health outcomes, we will be developing case studies of innovative areas of social policy from across the UK and internationally to inspire broader thinking and co-ordinated action from across government departments and the four UK nations.
We will also be exploring the potential to mobilise wider resources to influence the determinants of health, and support local action in doing so. The UK is rich in data which illustrates inequalities in health outcomes, such as life expectancy. Addressing the wider determinants of wellbeing and health requires widespread coordinated and sustained collaborative action across the public, business and voluntary sectors. We have been working with the Robert Wood Johnson Foundation in the US and learning from their programmes to build a culture of health. Over the next six months we will be scoping the value of developing a unit to act as a multi-sector integrator which would curate and amplify existing data, evidence and resources in order to support local action, creating a coalition for action on the wider determinants of health.
Finally, 2017 will see the start of a two-year inquiry to understand the future health prospects of young people. Much is understood about the importance of a nurturing environment during early years and the long-term harmful impact of adverse childhood events. However, less is understood about how factors in adolescence and during the transition to adulthood shape long-term health outcomes. We want to understand the extent to which young people, as they transition in adulthood (taken as aged 24), have the foundations for a healthy life. Specifically: the potential to engage in good-quality work; access to secure housing; a network of stable relationships and good self-esteem; and established habits that promote and maintain good health. Through research, engagement activities and deliberative conversations, we will seek to establish the current trajectories of young people over the life course and the action needed to ensure that the millennials and post-millennials are able to aspire to the long and healthy lives experienced by the baby-boomers.
Jo Bibby (@JoBibbyTHF) is Director of Strategy at the Health Foundation
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