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Determinants Inequality Public Health Social Value

The economy and a healthy population, a two way relationship

Last week I had to do a flash talk on the links between health & well being and the economy.

This was in the context of an event on inclusive growth, following the publication of the 2018 State of Sheffield report.

I was taking about the health and well being chapter (that my fabulous team wrote) on “why is health important for the economy”.

Main points below. The points are presented in speaker note format.

1) The economy is not what business does

Commercial economy – driver for growth, where most jobs are

Public economy – cost drain or investment for future

Social economy and individual / invisible. VSC= £900m?

Imagine what would happen to the commercial economy if there was 20% fall in number of informal carers, or no voluntary sector, or no state funded education system

How the individual chunks work is important. How the whole works together is more important

The welfare state (ie significant chunks of the social safety net for us all) is in a tricky position. Some argue it is being broken up and may be rebuilt locally. To be fair the welfare state has been creaking since at least 1990s. We ignored the signals, too difficult

2) The Economy, like all else, is inequitable

Nobody can quite set out a singular and coherent definition of inclusive growth that we all agree on.

Growth is inequitable as economy grows. This is the margin

Distribution of wealth is also inequitable. Trickle down theory is debunked, the rising tide didn’t float all boats, it led to more inequity.

The top 1% have all the wealth. This has downstream consequence

It wont be deconstructed quickly – took 1500 years to develop and huge power behind it

2) Health / wealth. Two way relationship

Do you want to retire? How healthy we are / not has critical implications on how actuaries advice govt re retirement age

HLE = 60. Thus 7 yrs of less than good health whilst working age

Deep inequality in this

Inequality in distribution of illness is an economic productivity issue, as well as intrinsically bad

a) Specifics – What sort of things are we talking about

Multi morbidity is more common in working age than old

Aged 60, 50% of people have >2 LTCs

Stroke (something most commonly associated with age) is more common in <65s than older. Many people loose significant function and don’t come back to work.

This is no an issue that will be solved by more, or better health care services. That is necessary but not sufficient

This has a direct and indirect impact on economy at individual and societal level

b) Healthy workforce and productivity

There’s a 25y gap in healthy life expectancy (HLE). Age of onset – 45 v 70 before multiple conditions become an issue.

Certainly has an impact on econ productivity

Estimates that illness costs Sheffield economy £1bn (as a comparator, NHS spend = £1.1bn)

100k working days lost a year to mental illness (under estimate??). MSK similar?

3) Keeping people well is thus a major national infrastructure project

A bit like HS2

With those kind of timeframes

How seriously are we really taking this.

(I’d encourage you to think hard about impact of 7y of austerity on LA budgets – the things that locally pay for “the determinants” of health, and what impact that may have in the future).

Economic prosperity AND health & well being are BOTH mission critical for the city

Read Saving Gotham for some insight into the approach to both improving health and why the Mayor of New York felt this was an important economic investment.

4) Business sector role?

A business could say well I pay my corporation tax, business rates, The state will sort out the investments necessary for healthy, well trained working age population.

3 reflections on this

the externalities of some business sector activities (gambling, cigs, booze)

Amazon, google – do they actually pay any tax

7 yrs stripping out state make the basic proposition increasingly unlikely

It’s in businesses interests to have healthy, well educated, skilled folk

5) Gig economy is a key concern

Worker rights and safeguards lower

Lower public revenue from this sector (HMRC concern)

6) Those not in work = biggest win?

Hence the importance of the work / health pilots

40% of working age affected by poor health by 2030.

Think about that in terms of economic productivity.

7) Of course, growing the economic is absolutely contingent on growing the commercial economy, growing jobs and the right kind of jobs.

There’s no doubt there

We neglect the background stuff here at our peril.

We neglect the inequitable distribution of resources, risks and assets at our peril.

The public sector, beyond facilitating and setting the right conditions for success, doesn’t have major role in the commercial economy. It has a huge role in the background fabric necessary to full economic success.

You will see these points are overtly tilted to one side of a two way relationship.

In brief the flip side is that employment and the economy more broadly is one of the most critical determinants of our health. I will come back to this one.

8) What to do? Two principal areas of response

a) Illness itself – prevent / delay is the only credible answer.

This is not a heath service issue, tho critical part to play.

Whole of society, upstream effort over many years

b) The role of large economic anchor institutions

£4.5bn in public sector in Sheffield. Capitalise on it. This is an economic issue associated with the economic power of those institutions rather than their service delivery roles.

Pick up from where our workshop with Ted Howard left off. Capitalise in terms of investment potential, procurement, land use, HR, skills development.

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