future governments will need to think locally when designing policies

What do the projections mean for the government’s ambition to tackle health inequalities?

Steve:

All the data we have seen so far, including in this new report, indicates that despite the government’s focus on improving the situation, this is simply not happening at a meaningful level. That’s not surprising, because many of the causes of health disparities are deep-rooted and not amenable to a quick fix.

Much of this is structural, and without preventative measures, things could get worse. Any future government will need to commit to long-term interventions to tackle health inequalities and be prepared to think locally when designing policies.

Jonathan:

Absolute. The report shows that 80% of the projected increase in serious illness among working-age adults will be in more deprived areas. That will have a major impact on the local economy.

And the more you zoom in on small geographic areas, the more uneven it becomes when it comes to how long people are expected to live in good health.

Most of the factors causing this inequality are far beyond the control of the NHS – whether they are avoidable risk factors such as smoking, or wider social determinants of health such as education and housing. The only way we can overcome inequality is by moving to a more preventive approach. And that is much easier for current or potential future governments to say than to actually do it.

What worries you most about UK health in 2040, based on the Health Foundation’s projections, and why?

Steve:

The increasing prevalence of long-term health problems obviously increases the demand for health and care services, but also has significant implications for the number of people who will need financial support from the state. We know that the longer you are on benefits, the longer you are likely to remain on benefits, so I worry about how this will affect two different age groups.

Primarily people in their early sixties. At LCP, we published a report last year showing that unless steps are taken to improve the health of people of working age, a significant number of people are at risk of being retired and receiving disability benefits for a decade or more. That would mean substantial growth in British benefits. Our report shows that without action, the total number of pensioners receiving Personal Independence Payments or Disability Living Allowance is likely to rise by around 60% over the next ten years – taking the total cost, in current price terms, from around £6 billion to £10,000. 5 brings. billion.

Secondly, and perhaps more worryingly, it is young people who already receive benefits at the start of their working lives. Without relatively early intervention, people can keep benefits forever.

What steps need to be taken to close the gap in Britain’s growing health inequalities?

Jonathan:

I think there is still a window in which we can intervene with preventive approaches. Otherwise we will be left with a huge group of people who will be left behind due to their health problems. This will have consequences for them, but also for their local economies and for society as a whole.

One of the most important issues will be finding a way to routinely measure the progress of all the drivers of health inequalities. Currently, even when you look at health policy documents, there is often a directly quantified target for something like reducing smoking in the population, and then something vague about reducing inequality. There is never a quantified goal. We need a currency that can help us understand what the current problems are, and how to prioritize action.

That’s why initiatives like the ONS Health Index are so important. They measure a range of issues that affect health and are outside the control of the NHS, but very much within the remit of other government departments, including education, work, pensions and transport. This data can help all parts of government do their part to improve the health environment, which will in turn improve the stock of health and prosperity.

Given the knowledge we have of these projections, what do you think leaders should do to prepare for the implications, especially in the more deprived areas, for the working-age population?

Steve:

We must do everything we can to keep people in work. It’s about moving away from the traditional job center model. There is now increasing recognition that barriers to work are often much more complex, including health, and that people need more tailored support.

There are relatively cheap preventive interventions that cost a fraction of the costs of someone having to spend twenty years on benefits. For example, personal care workers can stand alongside people stuck in economic inactivity and help them navigate the system and get the support they need, medical and otherwise. This individual, tailor-made approach can pay off – both for people’s mental and physical health, but also for the local economy.

There is early evidence from pilots that some of these interventions are quite effective. But inevitably, the Treasury is often skeptical of this ‘spending to save’ approach, especially when the money comes from different pots. More evaluation is needed to prove that these approaches actually save money and have a positive impact on the broader economy.

Employers also play an important role. We know that in the future there will not be as many younger people available on the labor market. Attitudes towards hiring older people will have to change as there will be a new commercial imperative to become an attractive place to work for people in their fifties and sixties. And because the likelihood of long-term health problems is greater among older people, employers will have to learn how to better provide the right support.

Jonathan:

I think we can do more to use the data we have on working age people receiving benefits to work out where and how we can provide targeted support. What are the main long-term health concerns behind the claims? And what preventative work can we offer earlier to others with that condition, to prevent them from later finding themselves in the same position where they feel like they have to stop working?

An example of this is that it is possible for someone with type 2 diabetes to observe for six or twelve months who is in a downward health trend and finds it difficult to control his or her glucose levels. If left unchecked, it will lead to significant adverse health consequences. It’s very predictable. But as this example of work with type 1 patients shows, with the innovative technologies we now have for continuous glucose monitoring, one nurse can monitor large numbers of patients in real time and provide targeted support to those who are struggling most. A similar approach in type 2 patients could yield interesting results. This is another area where evaluation will be critical to show the Treasury that these types of interventions are being made today and will really help us save tomorrow.

This content originally appeared in our email newsletter, which explores expert perspectives and opinions on a different health or healthcare topic each month.