This blog summarises a C3 Collaborating for Health paper, published in early 2017, which drew on a discussion with UK experts, and which includes many more details, examples and suggestions for action.
Chronic, non-communicable diseases pose a huge challenge for England’s National Health Service. But the NHS itself is overwhelmingly concerned with sickness rather than health. Instead, the levers of change in our everyday lives – the environment, organisations and individuals that shape our decisions on health – lie largely outside the medical world. Why do we so rarely succeed in large-scale interventions that pull these levers in ways that benefit the health of people in their local communities?
Thinking outside silos and across time
Too often, government departments and voluntary organisations do not fully appreciate the links between their own area of concern and wider health issues. This is particularly the case when the benefits of healthy behaviour fall outside the sector that is expected to make the investment. Additionally, some benefits may not be seen for years (for example, the fall in type 2 diabetes that would follow a fall in rates of obesity), well beyond the current political cycle. The only way to achieve real progress will be through long-term, system-wide thinking, and facilitating cross-sector design of interventions.
What, how and when to evaluate
Even an apparently successful intervention is unlikely to find funding to scale up if it is not supported by data to show that it works. But understanding the evidence takes time, money and expertise – which are often in short supply. Finding new, light-touch ways to capture and evaluate information, including qualitative evidence (notably stories), will be essential in spreading best practice.
Locally based health interventions may be highly dependent for their success on place and on the prevailing culture. Assessing the needs of specific communities, and co-designing any intervention to ensure that these needs are met, are key to success. Strong, understanding leadership encourages participation across sectors and within different communities – with the caveat that a programme is only truly sustainable once it no longer relies on a specific individual.
Where are the resources?
Prevention has always been the poor relation of health-care spending: in 2015 there were cuts of 7.4 per cent in local-authority funding for public health in England, and this trend is unlikely to reverse in the face of current economic pressures. But there are myriad local resources to be identified and activated – individuals who are keen to be involved, or assets such as leisure centres with significantly underused capacity. Let’s also do better in training professionals to appreciate the role that they can take in supporting and encouraging healthy lifestyles within their communities, whether pharmacists, teachers, faith leaders, business leaders, transport officials or health professionals.
Finding out – and understanding – what can be done
Communication leaves much to be desired! In England, public health has been located within local councils for nearly five years – but there are many relationships still to be forged between health services, local government and the influential local individuals who can build the trust and engagement that is needed to embed healthy-living programmes. And we all need new and accessible ways to share information about what works – and, crucially, what doesn’t work!
Creating a culture of health
Creating an environment within which health can thrive requires taking on numerous barriers that are features of modern life: the politics of ‘individual responsibility’ that seems to shy away from any form of government action in healthy living; the austerity measures that are driving funding cuts; vested interests such as the tobacco, food or car industries; the social norms within which overweight has become the ‘new normal’ (a misconception strengthened by ‘vanity sizing’ of clothes!); and the frequent failure to use audience-appropriate language to make the case for health (e.g. ‘productivity’ or ‘staff engagement’ will mean much more to business leaders than ‘health’).
As Lord Nigel Crisp has put it: ‘The UK was one of the pioneers in introducing a universal healthcare system available to the whole population. It could lead again in the development of a health-creating society.’
Is it too much to believe, in these Brexit-obsessed times, that this can still be done?
Download the report on why healthy lives interventions are so challenging.