A welcome shift in conversation

Two and a half years ago we published our strategy Healthy lives for people in the UK. At the time, starting a conversation about social determinants of health and health inequalities had a feel of arriving late to the party. People would say ‘but we know all that stuff’ and wonder why we were trying to resurrect an old topic of conversation. Despite this, it was apparent that all the markers of an equal society were on the slide. And that people’s awareness of the breadth of factors that shape a population’s health was limited. 

Two years on, it feels very different. Over the last year, with increasing regularity, there have been a string of reports in the press on the stalling of life expectancy, growing intergenerational unfairness, the depth of the cuts from the austerity agenda. The conversation seems to be shifting. Away from ‘why are you talking about this?’ to ‘what can we do about it?’. Most recently with the launch of the Deaton Review. Funded by the Nuffield Foundation, it will not just describe inequalities – in income, wealth, health, social mobility, political participation and more – it will seek to understand what causes them and provide concrete policy proposals to tackle them.

Furthermore, in policy discussions there is an increasing emphasis on prevention across the UK. Wales and Scotland have led the way with their Future Generations Act and National Performance Framework respectively. In England, the Department of Health and Social Care has signalled its intention to publish a prevention green paper. And while the spending review timescales are yet unclear, its prospect has created the opportunity for some serious discussion on spending priorities. 

All of this makes our Healthy Lives portfolio extremely relevant – almost prescient. And this month’s newsletter provides a timely update on some of the themes we are working on. 

In our interview with Dame Sally Davies, CMO for England, she talks about the importance of viewing the nation’s health as an asset – as something that requires investment if everyone is to be given the opportunity to contribute to society, community and family life. This concept formed the cornerstone of our 2017 strategy and the focus of our Social and Economic Value of Health research programme.

The piece on plain talking about what makes us healthy explores some of the efforts both within and beyond the Foundation to look at how those of us working in the health sector can communicate more effectively about the evidence of what makes people healthy. In a society that places a strong narrative on personal responsibility there is all too little acknowledgement of how the circumstances of people’s lives limit opportunities to be healthy. Without this fundamental shift in understanding, actions to improve people’s health will be inappropriately focused and, with it, under-powered.

An example of this is how the problem of unemployment and in-work poverty is addressed. Is it viewed and treated as a consequence of individuals not trying hard enough? Or a is it a result of economic strategies that fail to create equitable opportunities for high quality work? This blog from Yannish Naik and Miriam Brook examines the role of more inclusive economic strategies in improving people’s health and reducing health inequalities. 

Our chart of the month illustrates the importance of tackling such inequalities – showing that preventable mortality rates for men and women from the most deprived local areas are more than three times the rate for those from the least deprived.

After decades of rising life expectancy, it may not be surprising that this trend was starting to be taken for granted. It may be also understandable that, two and half years ago, people may have wondered why in the age of digitally enabled tech some of us were talking about the importance of ‘a home, a job and a friend’. But in the last year or so, the party playlist seems to have changed from D:Ream to Joni’s Mitchell’s Big Yellow Taxi. Let’s hope some serious policy action follows. 

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

This blog originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.