16 November 2020
The pandemic has put the issue of health firmly at the top of the social and political agenda. While its widespread devastating impact will reverberate for many years to come, the legacy of Covid-19 should also be a platform to choose a brighter future. It has highlighted the inextricable links between health and the economy as well as how healthcare services must evolve to meet the changing needs of patients and populations.
It is the issue that I explore with the former Chief Medical Officer for England, Dame Sally Davies in our new book Whose health is it, anyway? Our basic premise is that rather than illness being a cost, or drain on society, good health is an asset to our nation and communities. This however requires changes to our health system that can no longer be put off.
What is needed is a fundamental re-think of what health means, stepping away from seeing it in isolation from people’s wider environment and the economy in general. Health must be recognised as the key driver of prosperity, happiness, and social mobility in the 21st century and attitudes need to change. This requires substantial changes in both our healthcare system and wider health environment.
We need to value health differently
We are living longer but an increasing amount of life is lived in poor health. That’s why in this book we call for three parallel services across our healthcare system that effectively manage our health and care needs of today and tomorrow:
- a comprehensive acute illness service – to continue to be there at our time of need;
- a true health service for those living with chronic conditions – ensuring patients live well for longer in the community;
- a national Care system ensuring dignity and universal care in older age – applying the founding principles of the NHS from cradle to grave.
A new economic model
Covid-19 has highlighted the profound relationship between the public’s health, the economy, inequalities and the future of our nation. Despite this, our health environment promotes ill-health at every turn. The soft drinks industry levy was an innovative policy and has reduced sugar content while industry revenues have increased. Frankly, as a society we can no longer accept private companies particularly multinationals, not recognizing their responsibilities to either their workers or to the societies where they sell their goods and services. Companies should either ‘play’ by promoting their health of their workforce, and/or making their products healthier or ‘pay’ a levy into the Public Health Investment Fund towards improving the nation’s stock of health. This fund, coupled with continued funding of the healthcare system through taxation would provide the funding for this transformation.
Fundamental reform can only be backed up with a proper system of payment and monitoring. That’s why we need the creation of an independent National Bank for Health to oversee the nation’s stock of health, implement the framework for ‘play or pay’ and ensure we all value health differently. I was Chief Editor for Dame Sally’s 2018 annual report, Health 2040 - Better Health Within Reach, where we recommended the development of a Composite Health Index as a unit of currency across government to track contributions to the nation’s stock of health. This National Health Index, tracking key health data across outcomes and risk factors, would be the equivalent to this bank of what GDP is to the Bank of England and identify the areas of greatest return for the National Public Health Investment Fund to deliver total health. Done properly, this could deliver a recurring “dividend” to everyone in the country.
Data: providing actionable insights to deliver a healthier future
The pandemic has highlighted the inherent trade-offs faced by decision makers with finite resources, the necessity to account for the total health of individuals and populations and the vital role of increasingly available health-related data. Our work at LCP Health Analytics is ideally placed to tackle some of these previously intractable challenges. Our approaches, using operational analytics to improve the day to day delivery of healthcare services and to redesign care ensuring the patient remains at the centre can help realise the vision of a total healthcare system. Alongside this, our innovative approaches aim to bring clarity to the total health needs of individuals and sub-populations through identifying how co-morbidities clusters in those with long term conditions to inject life back into those extra years lived.
The pandemic has shown how vulnerable our society, economy and day-to-day life is to our collective ill-health. Now is the time to realise the opportunity of good health for our individual and collective prosperity and happiness. Health is a collaborative endeavour, with the citizen, NHS, academia, life sciences, and the technology industry all playing a part. But all this can only come to pass if we seize the moment and reimagine our future health together.
Jonathan’s book - Whose health is it anyway? - will be published on Thursday. You can pre-order the book here