Until 2020, as far as the UK was concerned, the rapid and devastating consequences of infectious diseases had diminished. As life expectancy grew during the second half of the 20th century, the largest causes of avoidable ill health became heart disease, cancer and respiratory illness – the non-communicable diseases that creep up slowly and have become a common experience as we age. These don’t appear through exposure to a single pathogen. Rather, their growing prevalence is determined by multiple social and economic factors, shaped by the resources and opportunities available to us as individuals through the course of our lives. While the COVID-19 pandemic continues to cast a long shadow, it is these diseases that account for the majority of premature deaths in the UK.
Two years ago, the then Chief Medical Officer, Dame Sally Davies, proposed the creation of a health index. This would be a new measure that would reflect the impact of the multiple factors that shape our collective health and provide a counterweight to the dominance of economic measures against which ‘progress’ has been measured for so long.
In December, the ONS published such an index.
It provides a marker not only of where we are as a country today, but also how healthy we are likely to be in the future. The launch of the ONS Health Index is an important milestone, recognising that the nation’s health should be considered a key measure of national success.
Good health is indeed an asset for both individuals and society. It underpins personal wellbeing and enables participation in family life, work and community. The pandemic hit at a time when improvements in life expectancy were stalling – and falling for some. Before the pandemic, some in the UK could expect to live 18 fewer years in good health simply because they live in a deprived area. And this past year has further emphasised that health and wealth are inextricably linked. There couldn't be a more important time to look beyond GDP as the primary measure of a government’s success.
At a time when protecting the nation’s health is front and centre, the index has the potential to play an important role in the government’s decision making around the recovery and ensuring that everyone will be healthier in future.
With the vaccine now being rolled out, it is everyone’s hope that life will start to return to pre-pandemic normality. But for many, without a major shift in the government’s approach, this will be unlikely. The experience of the past 10 months, and measures necessary to control the virus, have significantly eroded people’s material circumstances and wellbeing. Children have missed out on education. Families have fallen into hardship and housing insecurity as they have been furloughed or lost jobs. People of all ages have experienced loneliness and isolation.
This makes the ONS Health Index timely and important in focusing minds on what is needed to protect and improve the country’s health in the long term. Bringing together an array of indicators that reflect both how healthy people are today and whether they are living a life that supports good health in the future, the index has the potential to change the way decisions are made.
Political and financial cycles have for too long favoured the ‘quick fix’, prioritising the acute needs of people who are already unwell over the investments required to keep people well and out of hospital in the first place. If the health index comes to be viewed as akin to GDP – where continual growth is expected and desirable – then it has the potential to drive decisions that reflect a broader view of what makes for a healthy nation. Investment and policies that leads to better educational attainment, more decent homes, less air pollution and obesity are just some of the actions that will score in the index. And all ultimately leading to a healthier nation.
The ONS Health Index is described as experimental. It is published for consultation. There are, no doubt, aspects of the methodology that will generate fierce debate among experts. Many practitioners may say that it has been lack of political will – not lack of data – that has held us back from creating a healthier society.
However, in publishing the index the government has unequivocally laid out the connection between the country’s health and factors such as poverty, housing and green space. Just as we have seen that it takes the whole of government to manage a pandemic, this index shows that it takes the whole of government to create a society where everyone has a fair chance to live a healthy life.
Jo Bibby (@JoBibbyTHF) is Director of Health at the Health Foundation.
This article was originally published in the National Health Executive on 3 December 2020.