Keeping us healthy is not all about the NHS

28 February 2019

For years the British public have been told that staying healthy is their responsibility – so much so that they are starting to believe it.  

It’s no wonder that some people want to perpetuate this view. Much of the rhetoric about prevention places the responsibility for staying healthy firmly on you, me and our Fitbit. But this lets governments duck their responsibility to tackle the root causes of ill health. 

The recently-published NHS Long Term Plan puts preventing poor health at its heart, including finding and treating disease earlier and calling on the NHS to help tackle unjust differences in health between the best and worst off. These steps are welcome. 

But the numbers living with health conditions that could and should be avoided is rising. Whether we are talking about respiratory problems linked to air pollution, smoking or poor housing; cancers caused by obesity, tobacco and alcohol; or the increasing levels of depression and anxiety arising from myriad factors such as debt, loneliness and insecurity, they have two things in common. 

First, they all have roots in the political choices governments make. And second, by the time they are on the NHS’s radar it is largely a case of mitigating the consequences of disease rather than prevention. 

It’s not that the emphasis on prevention in the long-term plan is futile. Good NHS care can be the difference between your type 2 diabetes being manageable or it leading to your foot being amputated – the fate of over 6,000 people each year.

But just looking to the NHS to prevent ill health is akin to thinking that investing in prisons will reduce levels of crime. Of course, prisons have a role in preventing re-offending; they don’t stop people committing crimes in the first place. 

Poor health is the consequence of circumstances that limit people’s ability to secure the basics for a healthy life – a home, a job and a friend – thereby increasing their exposure to multiple risk factors. Any government committed to the prevention agenda needs to look far beyond the NHS.

Putting responsibility for keeping healthy on individuals alone sidesteps the root causes of ill health – poverty being common to most of them. It also diverts attention from the commercial interests of the food and alcohol industries. 

Yet the degree of control any of us can exercise over our own health is shaped by the conditions we find ourselves in. Living in poorer conditions increases the exposure to factors harmful to health: poorly-paid and poor-quality work, inadequate housing, greater air pollution, a lack of green space and affordable, healthy food. 

As highlighted by the Institute for Fiscal Studies, health care spending has risen from 23% of public service spending in 2000 to 29% in 2010. It is set to reach 38% by 2023-24.

Meanwhile, other areas of government spending that create the conditions for healthy lives have seen big cuts. Education spending has fallen by 8% per pupil in real terms since 2009/10, welfare changes since 2011 have cut incomes for the poorest households, and Sure Start and early years services have been cut by over 40% since 2010. 

Perhaps the starkest illustration of disconnected policymaking is the £85m cut to the public health grant announced before Christmas, when our analysis shows that they need an additional £3.2bn a year to meet demand and address inequalities. 

This situation is no longer tenable. The number of years lived in good health is falling for people who face the harshest socioeconomic circumstances. This is despite record spending on healthcare and medical advances. As such, there is a growing recognition that a healthier society is about prevention. 

Tackling the issue facing millions across the UK of spending years in ill health will only happen through a comprehensive prevention strategy that harnesses the contributions of all areas of government. 

This demands an industrial strategy that creates the opportunity for good quality work across the whole country, a more muscular commitment to regulating the food and drink industry – particularly where it impacts on children – and investment to bring back the social infrastructure that supports the most vulnerable. 

The government’s forthcoming prevention green paper provides the chance to do this and it must be done alongside adequate funding for wider public services that have a direct impact on people’s health, including those delivered by local authorities.

Creating a healthy society is good for all of us. The additional spending for the NHS will help mop up the poor political decisions of the past but isn’t enough to create a healthy future. 

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

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