The Health Secretary is right to focus on prioritising prevention and to put this at the heart of the upcoming Green Paper. Yet while full of ambition, it doesn’t read like a plan that will make a tangible difference to the nation’s health.
He has correctly diagnosed the problem – not enough focus on prevention across the life course – but the treatment he prescribes probably won’t give us the five extra years of healthy, independent life the Government so commendably called for earlier this year by 2030. There is no point encouraging people to adopt healthy behaviours if their work, their home and their community does the exact opposite.
The report rightly recognises the role our homes, workplaces and communities play in determining our health, but the Government largely places the onus on others to act, rather than outlining how it is going to contribute to creating healthier environments that enable us to make healthier choices.
There needs to be more investment and policy action to help people, particularly in mid-life onwards, to stop smoking, have a better diet, drink less alcohol and do more exercise.
Currently, at 65 years old we can expect to spend around a decade of our later years in poor health, with increasing numbers of us managing multiple health conditions. This is not inevitable. There are also scandalous health inequalities between rich and poor. People living in areas like Kensington and Chelsea can enjoy on average 18 more years of good health compared to people in places like Blackpool or Manchester. This is simply unacceptable. Bold actions across government on employment, housing and communities are needed to close the gap.
Firstly, work is important to our health. For those who sit at the wheel or computer screen all day, the lack of physical activity is a real threat to health. For others the physical demands and risks of work or the poor quality of work can be harmful to health. Mental health and musculoskeletal problems are the leading health reasons people are not working, and health and caring responsibilities are the leading causes of why people drop out of work before State Pension age.
The Government calls on employers to improve the health of their staff, for example by offering free fruit or cycle to work schemes, but there are also tangible actions the Government can take to ensure employers support people with health conditions to stay in work. For example, we know that offering flexible working options makes a huge difference to individuals who are struggling to manage their health conditions at work. The Government could change flexible working rules so that they are the default from day one, instead of after six months in post. They could also narrow the business reasons that allow businesses to deny people the flexibility they need to manage their health conditions while continuing to work.
Secondly, it’s great that the Government recognises the need to change our homes to help more people live independently. Our housing stock is one of the major determinants of our ability to age healthily, and yet, just 7% of our houses meet basic accessibility standards. The Government should insist that all new houses are built to minimum accessibility standards and ensure that local authorities have the resources they need to adapt and improve the condition of existing homes.
Thirdly, the places we live can encourage us to connect with each other and stay active – for example green spaces and walkable streets, active travel and public transport, community spaces to meet and opportunities to volunteer and participate in activities with other generations. Working with local authorities, the NHS could make a huge impact on how healthy and happy we are as we age. But this will require investment in local places and economic growth to benefit all parts of the country.
The offer of free fruit is helpful, but any interventions put forward in the NHS Long-Term Plan in December and the Government’s announced Green Paper on Prevention will need more bite. It is such an important opportunity to finally create the shift we need to enable people to have longer healthier and happier lives.