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The health of the people is an index of how civilized a nations is, but for a long time we have used healthcare as the measure, which has in turn has been conflated with expensive hospital care. For many years now, healthcare spending has been on an unsustainable trajectory.
There is now an urgent need for simple and cost-effective approaches to keeping citizens healthier and reducing the cost of care services. In Opposition, Andrew Lansley talked about becoming a Secretary of State for Public Health, signalling his belief in the importance of promoting health and wellbeing. In December 2010 the Government released its Public Health White Paper that put local authorities and local communities at the heart of improving health and wellbeing. Healthy lives, healthy people set out proposals to launch Public Health England, a dedicated “wellness service”, a Responsibility Deal between society, government and individuals, and a social marketing strategy that will “nudge” individual choice. This has met with mixed reception in the health policy community.
In 2011 Reform partnered with Danone to hold a seminar series on public health to explore the Government’s policies and the further opportunities to improve wellbeing and reduce the costs of ill-health. Specifically, we set out to explore the Hippocratic assertion that “the patient can be the best doctor”. We recorded and transcribed the seminars, to bring the discussions to a wider audience.
Costs and opportunities
Much of the rising burden of ill-health can be prevented through healthy lifestyles and individual choices. As well as the impact of smoking and excessive drinking in health, diet is increasingly proven by research to be a crucial factor determining health outcomes. Professor Cummings of Dundee University noted that “nutrition is hugely important in determining disease and particularly cancer, cardiovascular disease, diabetes and…obesity as well”. Dr Sarah Wollaston MP highlighted “over one in five adults are obese, and the same number for four to five year olds, and one in three of 10 to 11 year-olds”, while the cost of obesity to the NHS has been estimated at £5 billion a year.
As well as recognising the impact of diet in determining peoples’ health, the seminars also examined the curative role of food; that is, how “food can be the best medicine”. Healthy diet is as much as matter of quality as quantity and good food is not only important for prevention but also for recovery. Hydration is also a key component. Politicians looking for “quick wins” need look no further: when it comes to cheap, effective tactics, water is hard to beat.
Government and the health service
Few issues in public health are as controversial as whether Government can influence how people eat. Richard Cienciala from the Department of Health described how the Government has put “strong emphasis on supporting individuals in taking responsibility for their health… you cannot force individuals to do things”. Central to the policy is partnership between central and local government, the NHS, business, education, charities and individuals. Some called for greater government intervention. Yet as many recognised “this isn’t an area where government can leap in and do a whole range of things and wave magic wands, throw money and solve things.”
The role of the medical profession and the NHS in influencing diet was also debated. Professor Cummings was concerned that “there is a complete block in the medical world about using food to promote health”. Improving self-care among patients also requires the NHS to take a more active approach to supporting individuals, with Stephen Thornton arguing that “the only thing that’s stopping this happening is a mindset issue of how traditional providers of healthcare think about their particular roles and responsibilities”.
Business, society and the individual
The food industry has a key role to play in improving individuals’ diets, and, as Richard Cienciala argued, the Government’s Responsibility Deal offers “an opportunity to harness the huge influence of the food business for good.” Deborah Jamieson from the Department of Work and Pensions highlighted the role of employers in promoting healthier workplaces. Christine Hancock argued that it is about harnessing the force of business for good, suggesting that “industry has been good at getting us to eat and drink a whole range of things… and if they could get us to eat and drink different things or price differently, that is a long way part of the issue.”
In the end individuals must ultimately be responsible for their diet. The challenge is how to encourage better choices. As Diane Abbott MP asked “why is it hard for people to take personal responsibility over their own health and what they eat and drink?” Clearly, although across all seminars people highlighted concerns about lack of knowledge, poor skills, the cost of healthy food and the impulses of human behaviour, not everyone does in fact find it hard. Many make healthy choices all the time.
Since the most powerful determinant of healthcare is lifestyle and behaviour, the game-changer is to change behaviours. As William Beveridge once put it, the individual should recognise the duty to be well.PDF DOWNLOAD