Our health, more than just healthcare.
Improving population health has become an urgent priority. It’s not difficult to understand why when you consider that morbidity strikes 10-15 years earlier in some disadvantaged populations (David Buck, King’s Fund). We have got used to people living longer, that we have an ageing population, but in reality, in recent years, life expectancy has stopped increasing in England. Perhaps this is because health inequalities are widening and England is lagging behind. It is no surprise that demand on the NHS has been increasing, however much of that demand is for conditions, which are preventable: Smoking (which remains England’s biggest killer) and alcohol related illnesses; obesity and T2 diabetes.
Prevention versus Treatment
When the NHS Long Term Plan (LTP) was announced at the start of the year, there was a lot of emphasis on the need to focus on the value of people staying well for longer and staying out of hospital for longer. For that to happen there must be a focus on prevention rather than just treatment. The NHS currently remains essentially a treatment service for when people become ill, and prevention has remained underfunded compared to treatment. This will need to change if we are to relieve the pressures on the NHS and ensure its sustainability. There is evidence to prove that investment in prevention is cost effective but it will take longer to see results, meanwhile the NHS needs money now to treat everyone that needs it.
The LTP recognises that good health is about more than just healthcare. Duncan Selbie (CEO of Public Health England) described it as being not what the matter is but about what matters. He says that good health starts with having a job; a roof over your head; having a social life; someone to care for; being able to make lifestyle choices – all of which contribute to people feeling valued and most importantly promote positive mental wellbeing. With these wider socio-economic factors (education, housing, transport and leisure) in place, prevention becomes more attainable. Others have described being healthy as feeling like you belong, like you can participate and that you are recognised for whatever you do.
The NHS can’t do it alone
Integrated care systems (ICS) present a great opportunity to improve population health. However, support from central government, local councils, elected mayors, LEPs and communities themselves also have a vital role to play. The NHS can’t do it alone. At the moment, it has been reported that progress is being made but that leadership is a little fragmented and unclear, when it needs to be joined up. The Minister of State for Health has published a vision for prevention, identifying it as a priority and that a Green Paper will be published in 2019. Time will tell on whether this will appear, but never has it been more urgent.
Funding in the right areas will play an equally important role and the reductions in prevention funding will need to be addressed.
What can we expect?
Some areas in England have made progress in starting to address population health needs;
- Devon NHS commissioners and local authorities have established wellbeing hubs.
- Cherwell District Council has the Bicester Healthy New Town Initiative, whereby a new housing development is actively promoting and improving residents’ health.
- Manchester has a population health plan, which is fully integrated into broader plans for economic development.
- Bristol is creating partnerships between city planning, public health, NHS, university and police to develop its approach to population health.
The NHS will clearly be there to help people when they need it, but to thrive in the future will need to tackle the wider issues that are driving poor health. The overriding message is that good health needs to be the driver for the future of healthcare. Good health comes from good housing, good education, good jobs, good communities and good friendships and the NHS cannot be the sole driver. With the rise in attention on population health and the LTP having prevention at its heart, now is the time to make progress.
What does improving population health really mean? (The King’s Fund)
STPs a step on the road to fixing public overreliance on the NHS (National Health Executive)
The NHS Long Term Plan: Focusing on prevention to save thousands of lives (Public Health Matters)