Almost every aspect of our lives impacts our health and ultimately how long we will live. This includes our jobs and homes, access to education and public transport and whether we experience poverty or discrimination.
To ensure a stable economy and prosperous nation, attention needs to be paid across the whole of government to preventing ill health by recognising the impact of these wider determinants of health. Not only is this good for the population and good for the economy, it also relieves pressures on the health service.
Our recent webinar explored the economic case for investing in preventing ill health. Here we summarise some of the main points made by speakers as they discuss key trends in health and inequalities, and the importance of prioritising prevention in policymaking across government.
1. Growing ill health is impacting on the economy
David Finch, Assistant Director of Healthy Lives at the Health Foundation, sets out why government needs to take action on health prevention.
Over the decade preceding the pandemic, growth in life expectancy stalled, breaking a trend of steady improvement since the 1980s. An increasing share of the working age population is also reporting long term sickness, with a particular rise in mental health issues.
Financial austerity during the 2010s, which led to cuts in public services and social security, is partly to blame for this. It was also a time of stagnation in real earnings growth. And our income and living standards are vital for our health.
People’s health also varies considerably across different groups, with wide disparities in life expectancy depending on where you live in the UK. A greater share of the population in northern regions of England is diagnosed with ill health. People from Bangladeshi, Pakistani and Black Caribbean communities, for example, also experience more ill health.
One emerging consequence of growing ill health is that more and more people are reporting poor health as their reason for no longer participating in the workforce. This growing economic inactivity acts as a ‘drag on the economy’ and was happening well before the pandemic hit.
2. The government has failed to prioritise keeping people healthy
David argues that looking at policy decisions over the last decade shows how the government has failed to prioritise keeping people healthy. Whereas spending on acute health needs has to some extent been prioritised, other areas that make up the building blocks of health have had their funding cut, including education, transport, local government and housing.
In children’s services for example, spend has shifted away from early intervention over the past decade and there is now considerably higher spend at the sharp end – on safeguarding and looked after children. It seems the cuts to early intervention services earlier in the decade fuelled a need for even more acute spend in later years.
Often political needs drive a short term focus. But what’s needed now is for the government to take a more ‘prevention first approach’ to policymaking. That requires a political consensus on the need for long-term action on what improves people’s health and reduces inequalities. This is a whole society challenge.
3. Improving the nation’s health needs action across government
Jonathan Ashworth MP, Shadow Secretary of State for Work and Pensions (and previously Shadow Secretary of State for Health and Social Care), agrees that improving people’s health requires action from many different places.
Jonathan points out that debate about how to get people back into work has generally not taken into account people’s health in the ways it should. The two issues can be mutually reinforcing: being out of work due to ill health can mean being out of work for a considerable amount of time, which in itself can worsen your health.
While government policy has traditionally focused on disincentives within the benefits system to push people back into work, he argues the system needs to now put in place reforms to help people with ill health find quality work, including ways to:
allow people with ill health to try work without losing their benefits
decentralise how employment support is offered to enable local areas to adapt to local need
unite health and work services by offering employment support within health settings including addiction, primary care and mental health services.
4. Prevention is critical to achieving racial justice
Shabna Begum is Senior Researcher at Runnymede Trust. She explains that 18% of the UK population are from black and minority ethnic backgrounds – communities that are more likely to be ‘overexposed to those negative wider determinants of health that lead to poor health outcomes’. Preventative work that addresses those problems will therefore help to achieve ‘racial justice and a fairer more sustainable economy’.
However, she argues that approaching prevention in a universalised way, without considering race equality, will not address the structural processes that have resulted in that unequal landscape in the first place. This includes an awareness of how unequal the labour market is for people from black and minority ethnic communities, and the impact that racial discrimination can have on work and mental health for people from those communities.
Shabna says research for the Runnymede Trust’s report Broken Ladders showed that these are intergenerational issues – with people reporting that their children are now experiencing the same challenges they experienced when they started out in the workplace 30 or 40 years ago.
She argues that we need to recognise the racialised nature of the wider determinants of health, and how structural, institutional practices that are rooted in racism mean that black and minority ethnic communities are disproportionately affected by them.
So there’s a strong social justice case for investing in an intelligent, preventative approach as a way to build a more sustainable and fairer economy. Research shows us that people in black and minority ethnic communities often understand that it’s their housing or work conditions that are at the root of their health problems. Politicians need to be bolder in acting.
5. Funding flows need to recognise deprivation
Zoë Billingham is Director of IPPR North. She argues that taking action on preventing ill health is an investment in the future – economically, morally and socially. But that any action must take into account the ‘place dimension’ and understand the link between poor health and deprivation.
Regionally, certain areas of the UK are more deprived and therefore have a higher prevalence of ill health.
In reality, we’ve seen cuts to investments in the building blocks of good health, such as high quality housing. And public health funding has been cut drastically over the last decade, meaning less investment in anti-smoking strategies, public health advertising, and sexual health services – directly impacting on people’s health. Perversely, these cuts have disproportionately affected more deprived areas.
Instead we need to see public health interventions as an investment. The economic case for this is very clear. Health Foundation funded work has shown that in every year if you invest £3,500 per head in public health interventions, it will save the NHS around £13,500 a year treating ill health.
Zoë says we have to recognise the critical link between deprivation and health and change how public health and other broader activity that affects health is funded. This aligns with Health Foundation funded research from the Institute for Fiscal Studies which showed that reforming how public spending is allocated across the country is one of the most direct levers government has to effect the levelling up agenda.
6. There’s a big challenge ahead for the next government
Richard Sloggett is Founder and Programme Director of Future Health, and a previous Special Advisor to the Secretary of State for Health and Social Care. He says he’s seen a real appetite for the kind of cross-governmental working needed to take action on prevention, but that ultimately it will need prime ministerial leadership in order to get traction.
While there is an increased awareness in the impact of health inequalities following the pandemic, there also seems to have been a government shift in focus back to seeing health through an NHS lens.
This has led to the health disparities white paper being shelved, alongside a slowness to adopt the recommendations in the independent Khan review Making smoking obsolete and a delay to the government’s tobacco control plan.
Richard ends by issuing a challenge to whoever takes over the next government in 2024: