Whose Health Is It Anyway? Reframing how we think about our health

For more than 70 years the UK population has relied on the NHS to patch us up and cure our ills, but is our view of healthcare holding us back?

While we may be living longer, the evidence increasingly shows that we’re not necessarily living ‘well’ into our old age – with many of us living with more long-term health conditions and a growing gulf in life expectancy between the rich and poor.

Dr Jonathan Pearson-Stuttard from Imperial’s School of Public Health and former Chief Medical Officer Professor Dame Sally Davies are among those calling for a radical change in how we look at health and social care.

In a new book, they argue the case for a shift in how we value health: from seeing ill health as a drain, to valuing good health as a national asset.

They highlight how the acute impact of COVID-19 has laid bare disparities in the systemic drivers of health, and how the disproportionate impact of poor health is felt the most by those who have the least.

Ryan O’Hare spoke to Dr Pearson-Stuttard about the book, the future of the NHS, and how shifting our value of health could lead to a healthier population and a healthier economy.

Listen to the full interview, recorded in December 2020. Abridged answers below edited for style and clarity.

Why is good health valuable for the economy?

Jonathan Pearson-Stuttard: As we’re living longer, the gap in healthy life expectancy [between rich and poor] is getting more and more. We’re living longer, but longer of our life is lived in poor health and that’s where it starts to impact out economic productivity.

Being in good health is now a better predictor of future employment opportunities than education. Those with low levels of education but are in good health have higher rates of employment than those who have high levels of education but are in poor health.

Why are we still seeing see such disparities persisting in the UK?

JPS: One of the things we look at in the book is the ‘drivers of health’. We’re all very used to talking about the social determinants, but ‘determinants’ makes you feel that the decision has been made and there’s nothing you can do about it. Whereas, actually, each of these is totally modifiable, if society chooses.

For example, often the most affordable and accessible food is the most unhealthy, so if you are a low-income family, it’s difficult to eat healthily.

Similarly, if you look at smoking, while the average rate has declined the gap between the richest and the poorest has become bigger than ever. Smoking during pregnancy is such a stark example of that. In the richest areas, it’s down to 1%, in the poorest it’s 28%.

If you think of how big that gap is, and that’s playing through to life chances before that child is even born, and that really embeds those inequalities in there.

So whether it’s the housing environment or access to green space, at every level really this gap keeps getting bigger and bigger, highlighting the environment you’re born into and whether it’s a health-promoting or health-harming environment.

Are we looking at health the wrong way?

JPS: The underlying crux of this is that we don’t value health in the UK at the moment, we instead look at illness as being that drain.

If we were to value health differently, that would pay off. A healthier population leads to a healthy economy, whether that’s for your workforce or local community.

In the book, we talked about the healthy choice becoming the easy choice and a ‘play or pay’ concept, which builds on lots of the work done in the past from smoking and soft drinks lobby.

The idea is if you’re a company or employer, you should either play your part to improve the health of your workforce or local community, and if you don’t play your part you should pay.

That would be a levy that goes into a fund which is then invested, targeting the areas with the most need to ‘level up’ as quickly as possible.

What’s the biggest challenge for the healthcare service in the years ahead, and will the NHS survive?

JPS: I think it definitely will survive, because it’s such an important and integral part to the British population.

In most general elections, the NHS is up there, at least in the top three consistency, often at number one. That’s how much we care collectively about a service that keeps us living, and it does so much more than that.

But if we could go back, years before we’ve had that heart attack and need the NHS to keep us alive, then being in good health is that opportunity to prevent that but also it’s a big ‘leveller up’ in terms of social mobility and inequalities.

I think the biggest challenge for the NHS over the next 10 or 20 years is to modify how it delivers care and how doctors are trained, so it reflects the population – they’re not simple one condition, one box, one issue – and to reflect that holistic health and how we care for that person.

Ultimately, whose responsibility is our health – is down to each of us individually, or do government and industry have a role to play?

JPS: It’s all of our health collectively, and there’s lots of things we can do. Part of it is all of us appreciating the value of good health and to demand that.

From the political point of view, we can either be glass ‘half empty’ or ‘half full’, and I think there’s two areas I would look to be a little more optimistic this year.

The first is that while the COVID pandemic has just been awful, it has highlighted so many stark inequalities, as well as how the public’s underlying health and [a lack of investment in public health], has left us as a nation more vulnerable to the pandemic than other nations. And I think that will lead to some more action.

Secondly, the current UK Government was elected on a manifesto of ‘levelling up’ and in specific communities. Given that ‘levelling up’ is around employment and education opportunities, we’re identifying health being a key and pivotal part of that, and I think that does show some cause for optimism going forward.

Jonathan Pearson-Stuttard is a Clinical research Fellow in the School of Public Health at Imperial College London.

Whose Health Is It Anyway? by Sally Davies and Jonathan Pearson-Stuttard is published by Oxford University Press.

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