Determinants Health In All Policies

Health in All policies, why it matters to local government

I’ve written a little bit on Health In all Policies. A Previous blog on my 2017 DPH report explored the drivers of the population health problem and why it matters.

Many, including me, drone on about health in all policies.

Executing the rhetoric is hard.

The key issue as it I see it is that “Health” and indeed “prevention” is always something someone else does.

The mission critical part of heath in all policies is that the “health” bit of health in all policies is seen as the territory of “health” (which is mostly seen as a proxy for “NHS”) not the territory of the policy area of focus, say transport, housing or schools.

My suggested strategy is this

1) call it well being, not “health”. And 2) point out that the overspending part of local govt – adult social care – in mainly on account of our long term failure to prevent with an upstream population focus. The highways and planning committee have more impact on “health” than the FT Board or the CCG Board.

Change the nature of the conversation

We won’t sort out social care till we sort out the drivers of demand – poorly people – the population health problem.

In the long run, we won’t solve the social care demand pressures (the pressured bit of the SCC budget) till we solve the “health” problem (that often drives demand for adult social care)…..

We wont sort the population health problem, particularly inequality, by more or even better health and social care, we need to look to upstream.

New models of care or the integration of health and social care don’t look set to achieve giant financial saving on the basis of the evidence so far. It may lead to more efficient use of the same £ envelope, this is a good thing. It will only do so if we focus on culture and frontline, not structural integration, and a focus on need, demand and supply.

We wont solve the social care cost crisis till either funding settlement is sorted (seems unlikely) or we sort out the demand that’s driving it.

That comes from downstream consequences of poorly folk and certainly less than perfect well being. Wanless told us this 12 years ago. Everyone ignored it.

(A side point – It seems unlikely we will solve the NHS problem till we solve the problem of demand management (degradation of primary and social care) and drivers of demand (poorly folk again). Wanless told us this 15 years ago. Everyone ignored it.)

We wont solve the above problem will we solve the poorly folk problem, this involved focus on outcomes not costs. That also involves preventing bad stuff happening, a better, higher quality or even more health and social care won’t really solve the population health problem.

We can do that prevention one by one, Or we can do it by structural interventions that influence choices of populations – policies that drive poverty vs build more foodbanks to help people cope / invest in alcohol treatment vs licensing & Min Unit Price / lifestyle interventions to prevent diabetes vs sugar tax, or other structural interventions).

Experience from around the world shows that re-shaping people’s physical, social and service environments to support wellbeing, healthy behaviours and economic growth makes sound economic sense. Place, planning, housing, roads, transport, leisure are often not “in the conversation about “health. Thus the place we live and the way it’s ordered is important.

This isn’t an either / or conversation, all of the above interventions are good things. All the available evidence says upstream is the way to go – our transport choices, the economy, work, housing, education etc.

……so need to build bike lanes to help solve congestion and AQ issues, but also as cyclists tend to get less sick and thus use the NHS less and thus less need for social care etc. Doubtless there are many other e.g …..

Alternatively we could build bigger hospitals.

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