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Jo Bibby: It’s time to focus on the social determinants of health

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No one who has followed the news this winter is likely to disagree with the prime minister’s recent commitment to developing a long-term funding plan for the NHS. Yet extensive evidence shows that while the NHS may provide 100% of what we need when we are ill, it plays a smaller role in keeping us healthy.

Estimates vary, but as little as 10% of a population’s health is linked to access to healthcare. What keeps us healthy are the wider services that Beveridge set out in 1942 – services to prevent “want, squalor, ignorance and idleness”.

In the past 10 years, however, changing social conditions and seismic cuts to local government spending has meant the services designed to keep us well – including good social housing and early years education – are being silently eroded.

A third of people in the UK die prematurely each year, largely from diseases that could be prevented if we created the living conditions needed to keep us well. Furthermore, the uneven distribution of the services and environments that keep us healthy mean there is a difference of 20 years in healthy life expectancy between people living in the most and least deprived areas of the UK.

The Health Foundation’s recently published guide to the social determinants of health shows services such as education, transport and housing are critical to maintaining a population’s wellbeing.

So to provide more funding for health and care at the expense of other public services is a false economy. Local government services must be adequately resourced across the country if we are to assure the future health of the nation.

A growing body of scientific evidence shows that the foundations of a person’s lifelong health are largely set in the first 1,000 days of our life. Yet Department for Education data shows spending on services which support families in giving their children the best start in life is nearly half what it was in real terms compared to 2010.

Similarly, we know that socioeconomic status influences our opportunity for a healthy life. Yet over four million children are living in poverty in the UK, despite the majority being in working households.

Local government is uniquely placed to create healthy communities but investing in the conditions and services that keep people well is becoming increasingly hard.

The size of the challenge of health inequalities requires more than just service provision, it demands system change. This could be the Preston Model, that uses the employment and procurement opportunities of public sector organisations to generate community wealth and lift families out of poverty. Or it could be the changes outlined in the New Local Government Network’s report describing public health and economic development teams working together to secure benefits from inclusive growth. This is growth that doesn’t simply bring in new jobs, but which provides good quality work for local residents to address inequalities.

When it comes to providing services from constrained budgets, every penny must be spent effectively. This is only possible by understanding exactly what communities and families need and empowering them to find their own solutions and co-design provision with voluntary sector organisations. The A Better Start programme is a notable example of this, transforming early years support in five areas across England. And a recent report from New Philanthropy Capital amply demonstrates the contribution of the voluntary sector in keeping us well.

But addressing health inequalities in this country requires national as well as local effort. A healthy population needs long-term investment. However, we see time and again how meeting the immediate needs of treating people who are ill draws attention away from the investments that deliver benefit 20, 30 or even 60 years down the line.

Even so, governments do make long-term investment decisions: 90-year investments are made in securing our energy supply and 50-year investments in our transport infrastructure. Until government sees people’s health as critical to future prosperity and as important for long-term investment as our roads, rails and digital infrastructure – and until they recognise that keeping people in poverty, cutting education and social support simply builds up avoidable illness in the future – they will fail to make the best decisions on spending. More importantly, they will fail to create a society where everyone is able to flourish and contribute to the best of their ability.

Jo Bibby, director of strategy, The Health Foundation

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Readers' comments (1)

  • Xref The Black Report 1980 !

    Nothing has changed.

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