Creating Healthy Lives: A Whole-Government Approach to Long-Term Investment in the Nation’s Health
The health of the population is one of any nation’s greatest assets.
Life expectancy in the UK has been stalling since 2011, and there is an 18-year gap in healthy life expectancy between the least and most socio-economically deprived populations. Fluctuations in government priorities, a tendency towards short-term political decision-making, and challenges in addressing complex dynamic issues, all lead to insufficient attention by government on creating the conditions for a healthy life.
Over the past decade there has been a significant shift in expenditure across government, moving from spending on the services and infrastructure that help people stay healthy, towards addressing problems that could be avoided in the first place. This short-term approach is storing up significant problems for the future and runs the risk of widening inequalities in people’s health.
This research publication makes the case for an ambitious, whole-of-government approach to long-term investment in the nation’s health. The researchers recommend five shifts in the government’s overall approach to achieving this aim and outline how investment can be rebalanced towards areas of spending that maintain and improve health, such as early years services, housing and social security.
An effective approach needs:
- an explicit recognition of the value of good health in contributing to a more prosperous and flourishing society
- long-term thinking from government, with more focus on maintaining people’s health throughout their lives
- more joined-up policy action on the strategies that enable people to stay healthy.
The 5 shifts
Securing a future where everyone has the opportunity to enjoy the best possible health requires specific policy actions and investment in the right areas, but it also needs mechanisms that embed health and health equalities as a shared value across government and beyond. This requires government to show the necessary political will and leadership, to harness the full potential of opportunities in existing legislation, and to put in place structures that can counteract tendencies towards short-term decision-making and focus on a narrow range of issues. This will require government to:
- Change the way success is measured. Good health should be considered a primary measure of successful government. There are already examples of such approaches within the UK and internationally – most notably, New Zealand’s efforts to put non-GDP measures of wellbeing at the heart of government decision-making. This case provides an example of how using broader measures of success can create the right incentives for a shift towards long-term investment approaches within government.
- Embed long-term health considerations in legislation and policy across the whole of government. Mechanisms could include development of legislation such as the Well-being of Future Generations Act for Wales and the use of independent bodies to scrutinise and advise on health, in the way the Children’s Commissioner does for England.
- Prioritise investment in people’s health as one of the nation’s greatest assets. This will involve rebalancing investment towards health-creating areas of spending such as children’s services, housing and social security. Investment should begin with reversing cuts to the public health grant and making a commitment to maintain its value as a proportion of total health spending. In the longer term, finding ways to measure and monitor the balance between preventative versus reactive spending across government will be important to aid rational, long-term decision-making.
- Enable the NHS to play a stronger role in prevention, particularly as the integration of health and social care is set to progress rapidly in the coming years.
- Ensure that national policy enables coordinated, place-based approaches to improving health that involve communities and local government. Local government can provide leadership with other public-sector bodies but creating healthy social, economic, environmental and commercial conditions will only be possible with full involvement and participation of local communities in decision-making and action.
It will take bold political decisions at national government level and commitment over the long term to create the conditions for good health. There’s an opportunity now to set the direction for a healthier, more prosperous future.
The role of alcohol harm and alcohol policy solutions
Despite alcohol-specific deaths rates having increased over the last five years, the number of people receiving treatment for alcohol problems is down 11% since the high point in 2013/14. The success rate of treatment has also been falling: it is now five percentage points lower than it was in 2013/14.
Often policy success stems from a combination of policy levers and joint cross-government action to achieve a shared aim. There are four main channels of government influence, which in the UK tend to be delivered from the centre, and to a lesser, but increasing, degree through forms of local government:
- Taxation: Taxes are well known to affect the behaviour of companies and individuals through their effect on the prices of the goods and services they are levied on. Some taxes are designed specifically to reduce consumption (such as the high rate of tax imposed on tobacco products or, more recently, the soft drinks industry levy). Evidence suggests that taxing unhealthy foods, tobacco and alcohol can be beneficial to health and health equity.
- Regulation: The control of particular goods, services or activities have proved to be highly effective for tackling public health issues, especially on a national scale. The 2007 smoking ban exemplifies the large health impact such legislation can have but this also includes road safety measures, work standards, and gambling and alcohol licensing.
- Spending: This can take two main forms, the first being direct transfers to redistribute income, which from a health perspective can be important in alleviating poverty and reducing inequality. Second, directly funded service provision or investment in infrastructure can play a redistributive role, such as the provision of universal education. The balance of spending between proactive, health-creating services and reactive services is an important lever.
- Information: The provision of information can help people, businesses and other institutions to make more informed choices about the types of activities they engage in, or the goods they consume. However, it is important to understand the constrained choices people can be faced with when seeking to influence their behaviours.
An effective strategy to maintain and improve people’s health will need to maximise the use of all four of these levers in a concerted fashion.