Major conditions strategy: the case for change

There was a moment in 2021, at the point the Office for Health Improvement and Disparities (OHID) was being launched, when focus was finally given to improving the nation’s health and reducing inequalities. The then Secretary of State for Health and Social Care, Sajid Javid, said: ‘By focusing on preventing and not just treating poor health, [OHID] will tackle health disparities to break the link between people’s background and their prospects for a healthy life.’ This was to be the moment the building blocks for good health would finally be considered across the whole of government; OHID would coordinate activity across Whitehall ‘to address the wider drivers of good health, from employment to housing, education and the environment’.

Fast forward 2 years and this ambition is barely recognisable. A commitment to produce a standalone, cross-government health disparities white paper has been diluted beyond recognition. The agenda is now a minor feature in the major conditions strategy, a document rooted firmly in the Department of Health and Social Care and more specifically the NHS. While the document lists primary prevention – tackling the root causes of ill health – as a priority, there are no substantive commitments likely to reverse stalling life expectancy trends or the gap that exists between different areas.

There is only one new policy announcement in the prevention space: government consulting on adding pack inserts to tobacco products to encourage smokers to quit. This new policy is not enough to address the impact of risk factors such as smoking, alcohol and obesity on people’s health. The report is anchored in the role of clinical services and places too much focus on individual behaviour change and personalised prevention. This ignores broader evidence on the state’s crucial role in taking population-level action on risk factors and the wider determinants.

Having commented on previous moments when the ambition was watered down, it has become increasingly difficult to find anything new to say or be surprised by the lack of ambition shown. Perhaps it’s unsurprising then that the external commentary around the strategy is quiet, reflecting a feeling that there is nothing to gain by making the same points – again – accepting that a government in its last year of a 5-year term is unlikely to make bold, new moves in this space.

But the point that communities are being left behind by a lack of ambition and leadership is one to continue making. There will be very little impact on life expectancy without a new approach that has strong political leadership at its core. Manifestos for the next election will be the next realistic point for such a vision to be set out. A lack of ambition should be a concern for us all. The nation’s health is central to society’s strength and growth. We should be demanding more from government.

Katherine Merrifield (@KMerrifieldTHF) and Gwen Nightingale (@GNightingaleTHF) are job-share Assistant Directors in the Healthy Lives team at the Health Foundation.