Making Prevention a Political Priority - The Need and the Challenge

Prevention is better than cure

Our guiding principle is that prevention is better than cure. If we can reduce the risk of people falling ill (mentally or physically) this is potentially beneficial for:

  • Those who would have been affected and their families/potential carers
  • The NHS (reducing demand for NHS diagnosis and treatment to more manageable levels) and social care (delaying the ages at which people begin to need care)
  • Employers (potentially boosting productivity by reducing sickness absence and presenteeism i.e. attending work while unwell and under-performing while potentially infecting others, as well as experienced staff lost to the workforce to care for family members who are ill)
  • The government (by reducing Benefits payments whilst increasing income tax and national insurance contributions, as more people remain in employment; and increasing corporation tax and VAT income as a healthier population create and consume more goods and services)

But achieving prevention is challenging

The range of challenges to achieving this include:

  • The five year General Election cycle, which tends to encourage short term thinking by governments.
  • Lobbying and advertising by businesses whose products and services increase health risks.
  • A common public assumption that poor health is due to poor lifestyle choices and a lack of willpower rather than underlying socio-economic factors and companies who produce, advertise and provide unhealthy products and services – therefore assuming the focus needs to be on individual behaviour change rather than action to tackle the unhealthy environments people in deprived areas are often growing up in.
  • A potential loss of tax revenue from tobacco, alcohol, junk food, gambling etc. if people adopt healthier lifestyles.
  • Diagnosis and treatment and the means by which these are achieved (e.g. hospitals, doctors and nurses) tend to be more visible and the results more visible and immediate than e.g. public health measures.
  • The title of the NHS leads people to assume it is a national health service when, as the former NHS Chief Executive Nigel Crisp explained in the title of his 2020 book Health is made at home, hospitals are for repairs.

The Challenge of Transition

Perhaps the biggest challenge is how to achieve a successful transition from the current one-dimensional medical approach (waiting until people fall ill and then diagnosing and treating them) to a more holistic preventative approach.

This would be challenging at the best of times, as it requires the time, the political will and the financial and human resources to temporarily maintain existing services while at the same time developing, alongside this, a more preventative approach i.e. until such time as a more preventative approach can reduce levels of ill health sufficiently to enable NHS and social care expenditure to begin to fall rather than constantly increasing and until a healthier population boosts UK productivity and economic activity.

However, it is a particular challenge at the moment, given the many pressures the government is under (with pressure for increased expenditure on the NHS, social care, defence, prisons, education etc.)

This is probably a classic example of the urgent driving out the important. For example, with record waiting times for an ambulance, in AE, to see a GP and for an operation (the urgent) this may leave little time, money or political bandwidth to tackle the important (how to reduce the risk of people falling ill in the first place).

Some First Steps Forward?

Fortunately, a start can be made through action that doesn’t require government funding (and also by action that may increase government funding). Here are some examples: 

  • Legislation to require food companies to mass produce healthier food. Developments in food technology in recent years mean that sugar and salt can often be reduced without requiring artificial alternatives and without affecting taste and therefore sales, whilst food companies have the potential to add healthier ingredients, from fibre to Vitamin D, as some are already doing.
  • Fully implementing the 2023 Online Harms Act as rapidly as possible, to help protect children’s mental health in particular.
  • As the Children’s Alliance has proposed, increase the digital services tax from 2% to 6% and introduce a high fat, sugar and salt ‘Junk Food Tax’ and use the proceeds to support children’s health, to begin to reverse the transmission of health problems from children and young people through to adulthood.

Tackling Deprivation

We know that deprivation significantly increases the risk of poor health (both mental and physical) – so tackling deprivation is key to reducing the risk of poor health. There are probably no easy answers here. For example, raising the minimum wage may begin to reduce deprivation – or it may encourage employers to invest in AI to replace staff and reduce staff costs, with the lower paid often the most vulnerable. We have seen in the banking industry for example, how the number of bank branches and branch staff required has significantly reduced, as people now bank online or via apps and use ATMs to take out money. This is part of a business trend (seen also in self-service supermarket checkouts and baggage self check-in at airports) of businesses outsourcing to customers operations previously undertaken by staff. 

This suggests the need for a national debate about the future of work in the UK and both its economic and health implications – including how we can create the economic growth to finance the public services we need, while also reducing the current postcode lottery when it comes to people’s health.

We welcome all contributions to this debate!

Michael Baber

September 2024