Beyond the NHS

Addressing the root causes of poor health

5 June 2019

By John Dudding, Ben Franklin and Sally-Marie Bamford

4 minute read

This final report in the Centre for Progressive Policy’s (CPP) year long inquiry into the future of health and social care in England argues a radical change of direction is required and focuses on how to develop and deliver a social model of health.

From poor-quality housing to knife crime, from skills’ deprivation to in-work poverty and homelessness, CPP argues that the greatest socioeconomic challenges of our time are also our greatest health challenges.

New analysis from the Centre of Progressive Policy (CPP) shows 80 million life years are lost due to inequalities in education, income, employment, crime and housing in England:

  • 30 million years are lost due to education
  • 18 million years are lost due to income
  • 15 million years are lost due to employment
  • 8 million years are lost due to crime
  • 8 million years are lost due to housing
  • Circa 80 million lost in total due to socioeconomic inequality

CPP’s analysis shows how socioeconomic inequality in local areas reduces life expectancy and time spent in good health. For example, people living in Hull will live circa 4.2 years less due to employment (1.1 years), income (0.6 years), education (1.7 years), crime (0.4 years) and housing (0.2 years).

This latest report provides a compelling evidence base that future actions are required, and that we need to move faster and further than before.

It is framed within the context of rising health demand, a stretched NHS and a social care system at the point of collapse. It sets out a powerful case for change, exploring why there is a burning platform to address social determinants, taking stock of worrying trends in health outcomes, including a stalling of life-expectancy improvements and widening of place-based inequalities.

In this report we focus our attention on the social determinants of health as research consistently indicates that the wider social determinants account for a far larger share of health outcomes. The prevention agenda to a large extent focusses on behavioural change, such as smoking cessation or tackling obesity, but conspicuously overlooks the social gradient of health within our communities.

At this critical moment, it is important to think again about health policy – to shift away from the narrow definition of health simply relating to the work of the NHS and to consider health in all policies and places. To recapture the spirit of Aneurin Bevan – who was Minister for Health with a remit for housing – there is an urgent need to reorient health policy towards tackling the root socioeconomic causes of poor health.

This inquiry’s final report has reinforced this point and provided practical suggestions of how to better integrate socioeconomic factors within health policy making and vice versa. In this context, we have articulated what a social model of health might look like and how it can be delivered. It is predicated on five overarching themes:

  • More government spending on non-health related functions, and part of the health prevention budget ringfenced for addressing the social determinants of poor health.
  • Government departments at national and local level putting health first when developing public policy and evaluating impact.
  • Champions for the social determinants of health embedded at national (CMO) and local level (public health directors).
  • The NHS getting serious about its role as an ‘anchor’ institution – especially in poorer places.
  • Greater powers and resources for local areas to tackle entrenched deprivation in hard-to-reach communities.