Richard Sloggett is a former Special Advisor to the Secretary of State for Health and Social Care. He is the Founder and Programme Director of the Future Health Research Centre.
Covid-19 has had a devastating impact on the health and economy of our country, exposing our nation’s poor health and health inequalities, socially and geographically. The most deprived places have had double the Covid mortality rate of the least deprived.
Levelling up Health, a report for the All Party Parliamentary Group for Longevity projects, of which I’m a co-author, finds that there would have been 40,000 fewer deaths recorded if the national mortality rate had been as low as the least deprived places.
Poor health weakens our economic growth, nationally and locally. 1.2 million people aged between 50 and 64 are not working for health reasons. Health inequality between North and South costs £13bn a year in lost productivity.
In ‘building back better’ the Government rightly wants to promote economic growth. But it is not credible to think you can ‘level up’ economically without improving health locally.
Before Covid arrived, we knew that health outcomes were subject to wild and unjust variations. People who live in the most deprived places in England get ill 19 years earlier on average than in the least deprived places. In the UK the lowest socio-economic group has 24 per cent fewer people in good health than in the richest. In New Zealand, Greece and France, the gap is only five to ten per cent between the lowest and highest socioeconomic groups.
Public health policy measures to tackle such problems are regularly pitched as divisive. Between those who dismiss any level of intervention as needless ‘nannying’; and those who want to completely transform the whole of society into a socialist state. It is the easiest type of media row to generate. It doesn’t help tackle the problem.
And the data shows we do have a problem. Life expectancy has stalled in the last decade, and Covid has set it back even further. Healthy life expectancy is also stuck. Analysis last year showed that it would take Government until after 2050 to deliver the improvement within the Conservative manifesto of five additional years of healthy life.
Leaving this to the state or individuals alone will not solve it.
The case for a new consensus
We need to now move on from this division. The All Parliamentary Party Group on Longevity is a cross party group of parliamentarians seeking to build a new consensus on this issue for action. This is not the first time this has been tried.
The New Labour Government published a White Paper in 1999, Saving Lives: Our Healthier Nation. The model pioneered a “new, modern approach to public health – an approach which refuses to accept that there is no role for anything other than individual improvement, or that only Government can do something.”
The results of this and subsequent interventions were seen in increases in the rate of life expectancy for both males and females until 2010. Such rises have gone into reverse since. The Coalition and subsequent Conservative Governments have failed to tackle the issue. The last major public health strategy was in 2010 and focused on a responsibility deal with business that was voluntary, full of holes and failed to deliver. The 2019 Prevention Green Paper still awaits a response.
It is time for Conservatives to accept that doing nothing, on grounds of personal freedom or choice or responsibility, is not an option.
All three Conservative Prime Ministers have gone on their own journey to realise this. All started out as sceptics of action on obesity, but switched to becoming converts. David Cameron created the sugar levy, Theresa May’s pushed ahead with a second chapter of measures, many of which still await implementation. Boris Johnson has had his own conversion to obesity action following his illness with Covid.
The opportunity of reform
The approach that will deliver post Covid will be one that uses both state measures and the work of communities, places, peoples and individuals.
As others in this series of articles have noted, the Government is looking to build a new public health system on the back of Covid 19. The decision to abolish Public Health England will see Ministers taking greater direct accountability for public health and working across Whitehall to embed health more in policy decision making.
Our APPG report ‘Levelling up Health’ calls for an ambitious plan to improve our nation’s health over the next decade. It includes action at four levels: central government, setting the goal, the plan, funding, regulation, and committing to action on high priority public health issues; regional and local action, by harnessing the power of communities, the NHS and local and regional government; the individual, by empowering and supporting people to lead healthier lives; and action by business to support healthy lifestyles and restrict harmful marketing practices.
Our report also calls for the establishment of a much needed health improvement fund.
The Fund would enable 60 places with the poorest health and the highest Covid death rates to access additional funding to support health improvement. The fund (which would sit alongside the existing public health grant) should be set for five years, worth an average of £10 million a year for each place, costing up to £600 million per year nationally. Access to continuing funds would be based on performance against agreed annual outcome targets and deliverables.
This framework across different layers of Government and society will be the basis for starting to level up our health.
Health is wealth
Despite its size and importance, the NHS only contributes some 20 per cent to people’s healthcare outcomes. But it dominates discussion on how to organise our healthcare policy; usually through ever greater demands for more resources. In adopting a longer term, population and public health view after the pandemic, we can start to change how we see healthcare and the roles and responsibilities of all of those involved with delivering it.
The pandemic has regularly pitched the economy and health on different sides of the policy response. This is a false choice. Improving health can support the economy, which in turn can deliver improvements in health and wellbeing. The UK’s healthcare sector is often overlooked as a large, regionally based employer with high growth potential, and there are some superb centres of research excellence across the regions from Newcastle, to Manchester, Leeds to Liverpool.
With our science, data and technology capability in the UK – as evidenced through the vaccine development process – now is the time for an ambitious programme for delivering health improvement that supports our economic and global leadership ambitions. Levelling up health should be a pandemic legacy for this Conservative Government.