Health Care Isn’t the Key to a Healthy Population


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In the UK, National Health Service waiting lists are at record levels. Last winter, the emergency care system collapsed. NHS doctors and nurses are striking. We have a problem not just in recruiting people, but in keeping them. To save the NHS, we have to reduce demand and help the public live healthier lives. To name just one example, in April it was reported that over 5 million people are living with diabetes in the UK. In 2018, the government released a report saying that diabetes is one of the biggest burdens on the NHS, accounting for 9 percent of its overall spend. One in six people in hospitals are diabetic. Two-thirds of UK adults are overweight, a key risk factor for diabetes.

Before the pandemic, the King’s Fund reported that public health spending in the UK was about £3 billion ($3.82 billion), which is 15 percent lower than it was six years before. We absolutely need to increase public health investment again—but more than that, we must consider health in every policy domain.

Consider poverty. About one in five people live in poverty in the UK. Poverty has a serious impact on physical and mental health: It is associated with higher infant mortality, lower adult life expectancy, poorer mental health, asthma, diabetes, cardiovascular disease, and obesity. It has been estimated that getting your daily calories from healthy foods costs three times more than getting the same calories from poor quality food.

Housing is another big problem. According to the Health Foundation, one in three people report a problem with the affordability, security, or quality of their housing. Issues such as mold and damp can lead to respiratory problems and headaches. In January, a coroner called for better housing after ruling that a toddler had died from a respiratory condition caused by exposure to mold in his home. Overcrowding, among other things, increases exposure to infectious diseases. During the pandemic, it was one of the drivers of contagion among disadvantaged communities.

Green spaces are another massive issue. There’s a lot of evidence now proving that exercise is like a miracle drug. There is also plenty of evidence that if you provide more open, free, green spaces to people, you end up with higher levels of physical activity and improved mental health. In 2020, the government itself estimated that if every citizen had access to green spaces it could save the NHS billions of pounds a year. This is particularly important in helping children build a lifetime habit of exercise. However, young people in economically deprived areas are nine times less likely to have access to such spaces.

The government could prioritize quality housing, green spaces, and socioeconomic support. It could also address lack of work or insecure employment, indoor and outdoor pollution, and crime, all of which have considerable impacts on health. We need to realize that almost all governmental policies have an effect on public health and think more holistically about our longer-term health priorities. A healthier population is also a more economically productive and happier population, yet another reason every government policy should include a health impact analysis. If we can fix some of these issues now, we will reap benefits in the decades to come. Not next year, not in the lifetime of an election cycle, but certainly in 10 or 15 years. With demand for the NHS already outstripping supply, we cannot afford to wait.

This article appears in the July/August 2023 edition of WIRED UK magazine.

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