As we sentimentally celebrate the 65th anniversary of the National Health Service, we should remember that much of the improvement in health since 1948 – including an increase in life expectancy of around twelve years – is unrelated to what our health service does.
Perhaps we could also reflect on the widening gap between the health of the wealthiest and the poorest? In Stockton-on-Tees the life expectancy for a man varies by 15 years depending on which part of town you live in. The difference is not just about access to a GP and hospital waiting times, or just caused by smoking, alcohol and obesity. This is much more than bad individual choices and inequitable access to the NHS.
We know a lot about the causes of health inequalities, and the causes of these causes. Much of a person’s health is socially determined, and more health care is not always the answer. The NHS can inadvertently widen health inequalities, by offering expensive marginal health improvements to people in inverse proportion to their need.
It is unfair when people in one part of town can expect to enjoy 15 years of healthy retirement and live well into their eighties, while others just down the road hobble to age 65 and die almost a generation earlier. But we do have the opportunity now to set new standards for success. Most of our NHS budget so far has been spent on the failure of prevention. We can have better health and wellbeing if we are serious about investing in the underlying causes of ill health.
Improving children’s education and development, housing, employment opportunities, our environment and the wealth of the poorest will achieve an improvement in their health that will narrow the gap. It is only by refocusing our efforts on these social determinants of health that we will ultimately redress the balance.
Putting power in the hands of GPs in clinical commissioning groups was a movement in the right direction. But if we really want to change the social determinants of health we have to be more political. Public Health has now moved away from the NHS and into local authorities. The next step should be to enable the Health and Wellbeing Board to be the integrated commissioners of health, social care and public health.
Good leadership from local politicians who understand that expensive hospitals are part of the problem can release resources for prevention, early detection of disease, and for other health improvement interventions like the Family Nurse Partnership. Perhaps more significantly, the new director of public health in every local authority can use influence to lever health improvement into housing, transport and education spend.
If the family down the road has health problems, not only does that cost me money, but it also means I live in a less healthy society. As life expectancy continues to increase, the next decade should be one in which local authorities improve the health of the poorest quickest and reduce our reliance on the NHS. Sometimes less health care can bring better health.
Paul Williams is a GP, CCG lead for Stockton-on-Tees and GP public health lead for local authorities in the Tees Valley. He tweets @paulwms
Progressive centre-ground Labour politics does not come for free.
Our work depends on you.