At some point before the end of January 2025, voters will be called on to go to the polls in the UK’s next General Election. Over the course of the next 18 months, we will be urged to buy-in to manifestos from multiple political parties setting out how they believe they will make the UK a better place to live and thrive in.
The proposal that citizens should be able to live a long, healthy and happy life is right up there in terms of priorities for most, if not all. Two key questions are how we achieve that, and what policy choices are made to pursue it.
The cumulative evidence from multiple sources show that the nation’s health is in decline –almost a third of children in the UK are living in poverty, increasing numbers of adults are unable to work due to ill-health and millions of people are suffering with largely preventable diseases. The failed mantra of personal responsibility and individual will power somehow persists as a go-to in political and policy dialogue across the spectrum when it never has – and never will – solve any country’s health crisis.
Meanwhile, the gap in health inequalities is widening, with people in the least deprived areas of the country living 19 more years in good health than those in the most deprived areas. While many have suggested that the pandemic is to blame, widening inequalities have in fact been a persistent trend since the turn of the century.
Not only is this situation bad for the individual, it is also bad for the economy and there is increasing recognition of the inextricable link between health and wealth. For example, an estimated 149 million days of work were lost due to either injury or illness in 2021, affecting productivity of the economy overall.
The adage ‘prevention is better than cure’ is once again in ascendency amongst politicians and policymakers of all philosophies. However, action and investment consistently fall short of what is needed. For too long, Government spending has focussed on treatment, rather than keeping people healthy and preventing illness from arising in the first place.
In a major review in 2002, the renowned banker, Derek Wanless, predicted that this short-term strategy would do little for the health of our nation and actually make things worse. Twenty years later and his prediction has come true.
Treatment is not the answer. Helping people to be as healthy as possible for as long as possible will keep people economically productive and relieve strain on our stretched public services, which will have an added benefit for the economy. Good education, good employment and a healthy food environment do more to produce this healthy environment that the NHS, vital though it is.
If the UK is to grow, the current situation clearly needs to be addressed, and of course we expect to see a range of health-related pledges and commitments from all the parties in their upcoming manifestos. It is vital however that these pledges are not only realistic and achievable, but are based on knowledge and evidence so any resulting policy has a long-lasting, beneficial effect.
Directors of Public Health (DsPH) are experts in population health, with 175 years of experience of translating science into action, introducing and supporting initiatives that work on the ground at a local level to help people in their communities to live healthier, longer lives.
As the representative body for DsPH in all four nations, the Association of Directors of Public Health (ADPH), have harnessed this wealth of knowledge and experience to put together our own manifesto – a Manifesto for a Healthier Nation.
In it, we recommend that the next Government develops a new Public Health Act in England to ensure that health is put at the heart of all policy making decisions. This would follow moves already taken by the Scottish and Welsh governments and ensure that all departments can be held accountable for the public’s health as a result of their decisions and actions.
We also want to see a new all-encompassing strategy to tackle health inequalities, one with clear targets on how narrowing the current, unacceptable gap –which has been exacerbated further by the pandemic and cost of living crisis – will be achieved.
A new Child Poverty Act, which commits to ending child poverty by 2030, should also be introduced to ensure that future generations are given the very best start in life and are protected from harm, with equity in access to healthy food, accommodation, activities and education.
In order to achieve these ambitious targets, it is imperative that the new Government, when it comes, regardless of its leaning, recognises that the determinants of our health are much more complex than just the NHS. While the NHS of course has a part to play, our health is also shaped by economic, social and environmental conditions such as how much we earn, the education we receive, the housing we live in, the transport we use, and the air we breathe.
As a result, these other determinants must be funded consistently and adequately to ensure that the real causes of ill-health are properly tackled, and that money is not just given to the NHS to ‘fix’ us once the damage has been done.
For example, prescribing a drug to reduce obesity doesn’t provide lasting solutions. Instead, it carries with it the risk of serious side-effects for the individual and a 66% chance of returning to obesity within six months, creating a continuous cycle of treatment putting further strain on both the individual, the health system and the economy.
Additional and sustained investment into public health is therefore crucial so that DsPH can carry forward measures, in partnership across all sectors, that put prevention and protection at the heart of all they do and reverse the reliance on treatment.
As the NHS celebrates its 75th birthday, it is worthwhile noting that this year, we also celebrate the 175th anniversary of the Public Health Act, the 75th anniversary of the Town and Country Planning Act and the 75th anniversary of the National Assistance Act, which led to social care.
It is timely then for Government to make a renewed commitment to the health of the nation and we must recognise that health is a function of all departments of all governments and all organisations – at a local and national level.
We can turn the tide. It will ultimately need long-term solutions, but there are tangible things that can be done from day one of the new Government so we need our future leaders to take note and commit to joining us to get the building blocks right. Only then can we create a society where good health is the norm, not just the ambition.
Professor Jim McManus is the President of the Association of Directors of Public Health (ADPH).