Health in 2040: we need well-designed policies that help us to stay well for longer Q&A with Jim McManus, Association of Directors of Public Health

Looking at the projections in our report, what are you most concerned about and why?   

The projections are really quite stark. What concerns me most is the sheer volume of major illness that we’re going to be dealing with – that and the fact that most people will be living with more than one of these conditions. Our current health system will not be able to keep up with the level of demand we’re going to see. And it won’t be able to deliver good quality care to those who need it. 

I think the other thing I’m most concerned about is the economic implications of the projections. A 37% increase in people living with major illness is nine times the rate at which the working age population is expected to grow. It’s difficult to see how we’re going to afford this. Any policymaker who hasn’t read this report and doesn't give it serious consideration is in for a shock when they finally realise how this will change our economy. 

What do the projected increasing rates of illness mean for people’s lives?  

More and more people will need to make self-care and self-management of long-term conditions a routine part of their lives. This might mean knowing what you can do at home to alleviate breathlessness from heart failure or COPD; it could mean using physical resistance training to avoid frailty; or it might involve using psychological approaches to help with pain management. Supporting people to learn about managing their long-term conditions will be an important part of keeping people well and out of hospital as much as possible.  

Self-care and self-management will also be key to reducing the number of people who progress from having one major illness to having two or three. For example, we know that the more long-term conditions you have, the more likely it is that you’ll also have depression or anxiety. People will need to think about what they can do to reduce their risk of developing a second or third long-term condition, which might mean becoming more active, making changes to their diet, or working on their mental health and resilience. And it’s important to recognise that in all of these areas, people will need to be supported to make changes for the long term.   

What tangible things can people in power do now to improve the lives of people living longer, and potentially with major illness, in the future?  

The projected growth of illness will have impacts across the whole of our lives. We need to plan prevention that has similar systemic impact. We need policies that help people to live well with long-term conditions like diabetes, chronic pain, and anxiety and depression. That means more mental health support, investing in self-care and self-management, and making sure that employers give good support to workers who have long-term conditions. We need to invest more in community pharmacies and other primary care, so that people with major illnesses can be supported outside of hospital settings. This means things like being able to see a consultant or nurse specialist in a primary care or community setting, rather than seeing them at a hospital. And pathways from primary care to services configured to help you stay well. 

But if we really want to avoid a situation where so many people are living with major illnesses, then there are significant preventative things we need to do. One of the biggest improvements to people’s lives will come from policies that help us to live in healthy ways. This isn’t about education and willpower – evidence shows that while easy to say, these simplistic policy levers do not deliver the quantum of change we need. What we need are systemic policy measures that support people to make the changes that will help them to stay well for longer. That means things like active travel by default, supported by active lifestyle programmes which make physical activity part of daily life. It also means healthy food policy, which makes healthy food easily accessible and affordable for everyone. Well-designed policies can have a significant impact in supporting families and children to be healthy, starting from the early years. Finally, good mental health and resilience training, and work and study environments which support good mental health will be essential. All of these have a role in primary and secondary prevention. If all we do is head for primary or secondary care detection and intervention when symptoms arise, we will simply not reverse this trend. At the rate of change predicted we won’t even tread water. 

What else do you think needs to be in place to support people to live well for longer?  

We know that there are wide inequalities in the prevalence of long-term conditions, and we need to make it easier for everyone to lead more healthy lives. I think it’s essential for everyone involved in commissioning and providing health and social care to truly understand the experiences of people who have long-term conditions. If people are going to spend a longer portion of their lives with major illness, then we need services that are specifically designed to help them spend less time in hospital and more time in their own homes. This will involve making changes to how we design services and putting much greater emphasis on co-production with people who use health and care services. Inviting the people who will use a service to help design it is one of the best ways to make sure the service works for them. 

We also need to help people plan to age well, and configure services around that. Older people need to be seen as a gift, not a problem. To take one example, I love seeing increasing numbers of people in their 70s doing strength training in their local gym. Their presence can also change the atmosphere of gyms to make them more inclusive. That can only be to the good. Muscle strength and tone has so many benefits to help people age well.  

Ultimately, we need to make it easier for people to lead more active lives, through active travel policies and subsidies, and even by changing how we design houses and towns. Things like creating green walkways that link housing developments with community facilities and town centres can be an effective way to get people moving more. This is not about weight management – activity on its own is not the answer – it is about getting the multiple physical and mental benefits of physical activity into our daily lives by default.  

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