Winter pressures on health: An alternative perspective

Anyone who has spent time working in the NHS will hear the term ‘winter pressures’ and immediately think of the whole range of challenges the service faces at this time of year: increased demand from flu and norovirus, cancelled operations, medical ‘outliers’, and staffing shortages. All of them making a job - demanding at the best of times - more challenging for NHS staff.

Working on our healthy lives strategy, the idea of ‘winter pressures’ has taken on a new perspective. The pressures that mount in people’s everyday lives as the cold, dark months draw in. Some taking their toll immediately in increased ill health, others adding to the slow, persistent loss of health by stealth in the form of hardship, anxiety and loneliness.

Over the past few months, we have been running an infographics series on the theme of ‘what makes us healthy’. Two principles have informed the design. First, recognising that people are more inclined to act on positive inspiration than by stories and statistics that are overwhelming and feel intractable, our infographics have focused on the factors in our lives and environments that improve our health. Whether in terms of the benefits of green space, the contribution education makes to our health, or why good housing is a necessary requisite to good health.

The second has been to convey that, contrary to much of the prevailing narrative, being healthy is not an individual choice, it is shaped by our circumstances. And the more challenging these circumstances, the more limited the choices.

This month’s infographic illustrates this by looking at something many of us will be thinking about at this time of the year – food! A healthy ‘food environment’ is one where the food generally available to us is nutritious, affordable, accessible and attractive. The infographic evidences how for many, the choices available to them when making decisions about what to eat, or feed their family, fall far short of this.

It is hard to stand in other people’s shoes and appreciate how circumstances limit the choices available for them to live a healthy life. But the arrival of the winter months provides a valuable lesson on how factors outside our control influence the decisions we all make. By and large these choices tend to compromise our wellbeing and health.

How many of us have found ourselves exercising less as the colder darker weather has kicked in? Making the choice to drive or get the bus rather than walk? Our homes are probably colder and damper – not least as we drape wet washing over radiators and bannisters! Household budgets become squeezed as we turn up the heating and find that last year’s winter coats and boots no longer fit the children. The darker mornings and evenings are known to affect our mental wellbeing and for people living alone and less inclined to go out in the dark, loneliness can be a very real problem.

The consequences of this on our health – colds, coughs, asthma, depression – is clear. We haven’t changed but our circumstances have, and so our health becomes compromised.

It isn’t just the effects of the British climate that make it harder for us to live a healthy life over the winter months. Christmas, while providing some brightness and cheer, presents its own challenges. How many of us find ourselves spending more than we would like? Feeling the pressure to buy things we don’t really need and possibly can’t afford?

Fortunately for many of us, the pressures of winter and Christmas are temporary, we set our new year resolutions to eat and drink less, we get out and about more as spring arrives, we pay off our credit card debts and by the summer we have perhaps got back to the image of ourselves as someone who exercises good choices about our health.

But what if your life was always like winter? What if, your income meant you constantly were facing costs beyond your means – not to enjoy yourself – but to get by? What if it wasn’t the cold and dark that meant you didn’t get out as much as you should but it was the lack of green space or places to meet with friends and community? What if cheap high calorie foods were not an indulgence over Christmas, but the only way you could meet your growing children’s energy needs?

For the nearly 14 million people now living in poverty in the UK (8 million of whom are in work), these are very real aspects of their day-to-day life. Like the colder, darker days that challenge us all during the winter, these circumstances are out of their control. And the idea that being healthy is just about making better choices is as much a fantasy as… well… Father Christmas. 

Being healthy isn’t a lifestyle choice, it is about the set of circumstances people find themselves in. So, let’s make 2018 a year when we judge less, understand more and start to address the upstream, structural factors that mean, for example, a boy growing up in Glasgow City is likely to live seven fewer years than a boy growing up in surrounding East Dunbartonshire.

Jo Bibby (@JoBibbyTHF) is Director: Healthy Lives Strategy at the Health Foundation