Opinion: How to create a government for health, not just a department
To get the best value for stretched public resources, we need a whole government approach to develop a long-term plan for the nation’s health, says Tim Elwell-Sutton, healthy lives assistant director, the Health Foundation
A week used to be a long time in politics, but nowadays it seems that a single afternoon can change everything. In a time of turmoil, how can we make good long-term decisions? Can the machinery of government and civil service be employed to think beyond the immediate challenges of Brexit?
Some worrying trends in Britain's health are emerging, which need long-term policy and investment. Improvements in life expectancy, which have been steady the past 50 years, appear to be stalling. The health gap between the best- and worst-off communities is widening, with healthy life expectancy sitting at just 52 years in the most deprived areas, compared to 70 years in the most affluent areas.
Addressing these challenges is no small task, since the strongest determinants of our health are the social, economic, commercial and environmental conditions in which people live: issues that span the whole of government and beyond. The Health Foundation proposes five shifts to reorient the public sector towards building environments that create health.
1. Changing the way success is measure
The limitations of GDP as a primary measure of national success have long been discussed, but few countries have been bold enough to give other measures the same status as economic metrics. Notable exceptions include Bhutan, which uses a measure of Gross National Happiness, and New Zealand, which this year had its first ‘wellbeing budget’ using a framework developed by their treasury. Including measures of health as key indicators for evaluating policy success could create the right incentives for decision-makers in all parts of government to prioritise policies and investments that keep people healthy.
2. Legislation to embed long-term health thinking in government
Legislation is another possible route to better long-term decision making on health. The Well-being of Future Generations (Wales) Act places a duty on public bodies to work towards improving the wellbeing of current and future generations. It is supported by an independent future generations commissioner. Similarly, an independent commissioner for health (along the lines of the Children’s Commissioner for England) could help to ensure that new statutory duties are taken seriously.
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3. Investing in health as a national asset
The years of austerity have seen major cuts to public spending overall but also big changes to patterns of spending. From a health perspective, the general pattern has been towards greater investment in services that meet short-term avoidable needs, while cuts have been biggest in areas which promote long-term health. For example, between 2015/16 and 2019/20, spending on NHS England grew 8% on a real term per head basis, compared to a 23% cut in the public health grant over that time. In local government, spending on children’s services has become increasingly skewed away from initiatives that prevent problems arising (eg Sure Start centres) and towards the costs of more children becoming looked after by the state. When resources are tight, it is understandable that decision-makers focus on the most urgent problems, but these trends risk creating a vicious cycle by storing up avoidable demand for the future.
4. Enable the NHS to take a strong role in prevention
The NHS is primarily focused on treating sickness but there is much more it could do to prevent illness. Harnessing its institutional power is key. As the UK’s largest employer (of 1.6 million people) and a major economic actor in terms of its procurement spending, the NHS has huge potential to improve living conditions for healthier lives.
5. Support place-based approaches
Many powers to create healthy environments sit with local government (think of planning, transport, parks and leisure services) and local communities can play a vital part in making change happen. Many local authorities, like Wigan, are actively working to change the relationship they have with local communities, building a more collaborative approach. But these moves also need the (political and financial) support of central government to make this a reality.
Ultimately, building and sustaining a whole government approach to improving the country’s health will need more than good policy or supportive structures. It needs a national change of mindset. If we start valuing health as much as wealth, and learn how to prioritise long-term investments, it is possible to create the right conditions for to lead healthier lives.
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