Thanks to medical advances, rising living standards and, more recently, improvements in some lifestyle issues (notably falling smoking rates), the UK has seen nearly a century of increasing life expectancy.
But progress has now stalled, improvements in life expectancy are stagnating, health inequalities are widening, and England’s health outcomes are mediocre compared with other countries.
In this context, The King’s Fund has launched ‘A vision for population health: towards a healthier future’, which sets out what we think needs to happen next and why.
If we are serious about addressing these challenges, we need to move away from a system focused on diagnosing and treating illness to one that prevents people from falling ill in the first place and does more to support those who need it.
Two things are needed to make this happen. First, resources and effort should be rebalanced towards those things that determine our health in the first place. All the evidence shows that it is the wider determinants of health that are most important. That means investing in decent homes and education, reducing poverty for those in and out of work, and improving the air that we all breathe. We should see these as investments in the health of the population and value, resource and regulate for them accordingly.
“Local government has a critical role to play, as a deliverer of key services and as the local institution closest to communities
Second, stronger action and understanding is required locally on the connections between the factors that determine the health of local populations. Our report identifies a framework for population health based on four key pillars that affect health: the wider determinants, population lifestyle and behaviours, the communities we live in and with, and an integrated health and care system. We argue that local areas need to be much more focused on the interconnections between these pillars.
Local government has a critical role to play, as a deliverer of key services and as the local institution closest to communities. In the UK, local government and the NHS have separate systems of leadership, funding and governance, making this active coordination even more crucial.
For example, we know that decent, warm housing keeps people well and out of hospital. Yet there are few instances of where NHS funding is used directly to improve the quality of housing as a preventative intervention – unlike in health care systems in some other countries.
In principle this should be possible, as the arrangements for local system leadership and coordination to improve population health are in place through health and wellbeing boards, sustainability and transformation partnerships, and integrated care systems.
However, these structures have overlapping roles and their relationship is often unclear locally, resulting in a lack of consistently effective leadership for population health. We urge local and regional partnerships to use our population health framework to review their activity and leadership responsibilities for population health.
Local effort needs to be backed by national support and funding. We are pushing central government to focus the work of government departments, local authorities, the NHS and other agencies by establishing binding national goals for population health, underpinned by a new national strategy on reducing health inequalities.
Muddling through will not be enough to make progress towards a healthier future. Action at the national, regional and local level is needed if we want to continue living longer, healthier lives.