Beyond the short-term

To plan well for the future, public health teams, councils and health services must have as clear a sight as possible of the pressures and opportunities ahead. 

One clear future strain on our health systems is demographic change and the resulting demand on public services because of ill health. Between 2018 and 2028, the number of people aged 75-84 years in England is projected to increase by a third, and those aged 85 years and older by more than a fifth. 

During this period, the number of people aged 75 years and older living alone is forecast to increase by 461,000 – a population equivalent to the size of the city of Bristol. 

Away from demographic change, is there any way to forecast health in our population in five, 10, 15 years’ time?

The Health Foundation’s REAL Centre produced an insightful report posing an answer to these vital questions. Its 2023 report, ‘Health in 2040: projected patterns of illness in England’ provides independent analysis about predicted future levels of illness in our population to support policymakers and leaders in health and social care with better long-term decision-making. 

Its analysis indicated that more than nine million people in England alone are anticipated to be living with major illness by 2040 – this is 2.5 million more people than in 2021, up more than a third. We know that much of this rise can be attributed to our ageing population and increases in life expectancy. While living longer is certainly something to be celebrated, there will undoubtedly be implications for our health and care services, such as rises in demand and complexity. 

The magnitude of the challenge extends beyond England, as many other nations worldwide face a comparable demographic scenario, witnessing their populations age at a similar pace.

In England, as referenced above, the number of people living with major illness is projected to increase by 37 per cent – over a third – by 2040. By comparison, the working age population (20 to 69-year-olds) is projected to increase by only 4 per cent. This population group will be responsible for generating the bulk of government revenues used to fund public services, including the NHS. This would create additional pressures on us all to care for and fund a growing population with high health and care needs.

A significant proportion of the projected increase in ill health relates to conditions such as anxiety and depression, chronic pain and diabetes, which are predominantly managed in primary care and the community.

This reiterates the need for greater investment in early intervention and prevention to reduce the impact of illness, keep people in good health for longer and improve the quality of people’s lives. 

Poor physical and mental health shortens lives lived in good health and impacts not just on individuals but on their family, friends and their communities. It has a significant detrimental impact on the economy through reduced productivity and increased demand for public services. It is a vicious cycle that needs to be broken. 

This stark situation is unfair and avoidable, and calls for urgent action at a national, regional and local level, not just by public health teams and our NHS partners, but by all those who have an interest in the future prosperity of our nation. 

While detailed evidence on the drivers of population ill health is still emerging, individual factors including lifestyle, the environments in which we live, and our genetics account for between 70 to 90 per cent of what represents our health. In contrast, treating ill health accounts for as little as 10 per cent, but consumes more than 90 per cent of available health resources. 

Health-care demands will continue to increase while costs are spiralling as health takes up an ever higher proportion of public spending. Simultaneously, outcomes are deteriorating, with life expectancy beginning to reverse and health inequalities on the rise. This is only set to worsen if these stark projections become reality by 2040. 

These problems are being driven by our current approach, which is almost entirely focused on treating sickness. As a result, our NHS is regularly overwhelmed by rising demand, with an estimated 7.6 million people waiting for treatment. 

“Our current approach is almost entirely focused on treating sickness”

Critically, with 2.8 million people out of the labour market because of long-term ill health, any sustainable plan for growth needs to have improving population health and prevention at its heart.

Public health: a plea for 2040

Public health, working across all of local government’s functions, can make a real, large-scale difference to promoting the independence of people with long-term chronic conditions, to preventing ill health and therefore to reducing pressures on the NHS, as well as to its primary goals of improving wellbeing and reducing health inequalities. 

Public health teams, working with a ‘health in all policies’ approach across councils, are tackling persistent problems like obesity, mental illness, alcohol abuse, and the health impact of isolation and loneliness in old age, as well as addressing some of the serious health inequalities that still exist within and between communities. 

However, the public health function of local government cannot continue to maximise its role while continually being left without any choice but to make budget cuts. We must not get used to the NHS and social care being in a permanent state of crisis. Public health could help make this country one where people live healthy lives for longer with less dependence on acute health and care services and a better quality of life, while reducing the public service budget in the long term.

“We must not get used to the NHS and social care being in a permanent state of crisis”

More broadly, we need a paradigm shift. We must begin to treat individual and collective health as a national asset. Current and future governments should focus their efforts and resources on creating the conditions in which population and individual health can flourish. 

This means much greater attention directed towards preventative health measures alongside support for the drivers of good individual health. With an enabling policy infrastructure and shifting towards prevention and early intervention, it will be possible to increase population health, unlock long-term economic growth and make Britain fit for the future.

Only with a clear sight of impending pressures and a shift towards prevention, can public health teams and policy makers truly plan and develop health services fit for the future. With a growing understanding of the vital importance of the nation’s health and a commitment to improving health and wellbeing for those most at risk, we can be optimistic that public health will continue to grow in confidence and effectiveness for 2040 and the years to come.

We will be discussing these issues (and other key topics) with leading experts and councils at the LGA’s and Association of Directors of Public Health’s annual public health conference from 19-21 March, across three mornings (on Zoom). You can view the full programme and book your free place at the LGA website.


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