Shaping our strategy to improve health

If you follow Health Foundation news you may have noticed a different flavour to some of our more recent publications. A focus on what is variably called public health, population health or health and wellbeing.  So, what’s going on you may be wondering, are we expanding our horizons? In short – yes! But perhaps it is worth taking a bit of time to explain why and what we are hoping to achieve.

High quality health care is something we are fortunate enough to be able to take for granted in this country. We know it can be better, and we know it needs to change to meet future challenges, so our work to support improvements will continue.

However, it is now widely accepted that our health care systems, however good they are – and the NHS is one of the best – are not the largest contributors to our overall health. Estimates range from 10% to 40% of our health being a result of our access to health care with the rest being determined by wider social, economic and environmental factors. In concrete terms this is our housing, our income, our diet, our exposure to pollution and our education.  As I heard someone say recently ‘health is what happens to us when we are doing other stuff’. And so, if we really want to improve people’s health we need to work on ‘the stuff’.

Working on the ‘stuff’ is complex and huge and we are thinking carefully about where we can best support change.  It is apparent that while we have much to offer from our existing experience and expertise, in such a vast field, partnership will be essential. July’s newsletter starts to share some of the initial moves we are making – the beginning of a wider dialogue about our contribution to this agenda.

In January this year, we hosted, with the Robert Wood Johnson Foundation – a US-based Foundation with a broad aim of building a culture of health – a session of the Salzburg Global Seminar on the theme: Hooked on health care? Exploring better strategies for improving health. From a series of rich and diverse discussions we identified the importance of changing the conversation from ill health as a burden to health as an asset, and providing the evidence to make this case. The flavour of this discussion is captured in the record of a conversation I had with the Director of the Robert Wood Johnson Foundation, Karabi Acharya.

Perhaps because of the tendency to view health as the responsibility of the health care system, there is an implicit assumption that health is something we can (or can’t) ‘afford’ depending on whether or not we have a prosperous economy. We often lose sight of the fact that health is actually at the core of a prosperous and flourishing society. To challenge this thinking we will be looking at how we can build the economic and social case for health as an ‘input’ to a flourishing society, rather than the output of public spending. My colleague Louise Marshall explores this idea further in her blog this month.

However, as well as recognising that health is an asset for society that merits investment, it is clear that there also needs to be a much more coordinated approach across government (national and local) to align decision making with the aim of maintaining and improving health. There can be no sense in one part of government taking decisions that reduce life chances and longer-term health outcomes, simply for another part of government to have to manage the consequences later down the line.

The case for cross-government action was the theme of our recent event and essay collection  A Healthier Life for All, jointly published with the All Party Parliamentary Group for Health. In our interview with Sir Liam Donaldson, one of the essay authors, he reflects on his experience of how governments have approached public health differently over the years and the impact this has had on health inequalities. The report is just the start of the conversation and we will be continuing to consider practical steps for putting health impact considerations at the front of policymakers’ minds.

And while national action is essential in improving health, it is in communities, in our daily lives, that our health is shaped for the better or worse.

Our June QualityWatch report, published jointly with the Nuffield Trust, took a critical look at the current state of public health following its transition to local authorities. This move facilitates many opportunities for public health to influence local decision making on housing, planning, transport – all factors that affect our health. For this to be fully realised, Alisha Davies argued in her blog that we will need to develop our thinking as to what represents indicators of effective public health action.  We need to move beyond simply the effectiveness of public health services to look at how effectively public health teams mobilise the wider community assets that shape health.

So we are becoming aware of the breadth of the challenges and opportunities the Foundation will need to consider as it shapes its strategy to improve health. We are building many great relationships with those of you already on this journey as we shape our strategy, some of whom were able to join our Healthy Lives event last month and share their experience and insights.  I hope that through this newsletter we will build many more so please do share your thoughts in the comments below on how the Foundation can make the greatest impact on improving the health of people in the UK.

Jo Bibby (@JoBibbyTHF) is Director of Strategy at the Health Foundation