By Greg Fell
Health and wealth is a two way relationship. Here is why…
The economy is everything, everything is connected.
The economy is not just about the activities of private sector business. Investments in the public sector, voluntary sector and the actions of individuals all contribute to outcomes we individually and collectively value and thus what we consider “the economy”. Sometimes measurement and valuation is difficult, but that doesn’t make it less important. Everything is connected.
Healthy Life Expectancy is an economic issue.
Healthy life expectancy is the age to which a person can expect to live in good health. In the UK healthy life expectancy is 63.1 years for men and 63.6 years for women. With the retirement age rising to 67 by 2028 this means on average we will be working for 3-4 years in less than good health. So how healthy we are (or not) has critical implications on how actuaries advise the government about the retirement age.
There is deep inequality in the distribution of illness. This is an economic productivity issue, as well as intrinsically bad. There is a 25 year gap in healthy life expectancy so a baby born in the most deprived areas can expect to live to just 45 years old in good health whilst a baby born in the most affluent will reach 70.
Inequalities in health are intrinsically linked to inequalities in economic outcomes.
Many people and organizations have commented that the way in which the economy has developed has left people behind and often exacerbated poverty. There is a strong research base on this, and this has led to the establishment of terms like “inclusive economy”, which describes an effort to ensure the economy works for everyone. Given that health inequality is essentially driven by wealth inequality this underscores the importance of our efforts around creating an inclusive economy as important for reducing inequalities in health and wellbeing.
Multi-morbidity (having more than one condition) is more common than having a single illness. It is more common in working age adults than old adults, and (you guessed it) is very unequally spread across our population. As more than half of over 60s have two or more long-term conditions this makes preventing, and delaying and treating, those conditions a quality of life and an economic issue. And as more deprived areas have more people out of work due to long-term health conditions for more of their working lives, economic growth in these areas is that much more difficult.
The Sheffield Example
Illness costs the Sheffield economy an estimated £1bn (as a comparator, the NHS spend in Sheffield is £1.1bn) every year! 100,000 working days are lost a year to mental illness, and a similar number for musculoskeletal conditions… to name just a couple of examples.
So what does this all mean and what can we do about it?
Simply, a healthier population is likely to be more economically productive (and to need less spending on healthcare and health-related benefits). This is a two way link as a more prosperous society is likely to be healthier. Just as HS2 is seen as an investment in the economy, so is investment in a healthy population.
We should consider health as a balance sheet asset, not a cost.
What we measure and value is important. This is one of the things that underpins calls to widen the measure of economic growth from solely gross value added to a wider measure that includes social benefit. It would be easy, in narrative terms at least, to also include resilience and cohesion into the things we value in our economy.
Health and wellbeing should be a central component of economic strategy. The above issues are not issues that will be (only) solved by more, or better health care services. That is necessary but not sufficient. Poor health has a direct and indirect impact on the economy at an individual and societal level. So the central “health” challenges – stalling healthy life expectancy, and inequalities of that – aren’t just a problem for the NHS, they are a problem for the whole economy. Keeping people well is a major national infrastructure project. A bit like HS2. With those kind of timeframes. How seriously are we really taking this?
Once we start to treat health as a linchpin to community and economic development, we can begin to insist on different investment decisions and improve our programmatic approaches to power boost results.
See here for some references to support the above.
By Lucy Gavens
Earlier this year a group of intrepid researchers launched SIPHER – a new research Consortium that hopes to improve health and wellbeing and reduce inequalities. We have found that policy makers often struggle to articulate and defend the case for upstream action to address downstream health crises. This is particularly acute in current times as we see ever greater investment in NHS services to treat illness at the same time as funding for preventive action to improve health and wellbeing is squeezed year on year.
Our vision is a shift from health policy to whole-systems healthy public policy driven by new evidence we develop with policy makers. We are working with 3 policy partners to test out our ideas and develop models and tools that can be used by decision-makers across the UK (and further afield!) to design policies to improve health and wellbeing and reduce inequalities.
What is different about SIPHER?
A number of different research groups and organisations have been taking great and positive steps to progress a healthy public policy agenda for many years (e.g. The Health Foundation, The Institute for Health Equity). SIPHER seeks to join these ambitious groups with a few key features that we feel set us apart.
Firstly, as you can imagine, most areas of public policy are complex systems where policy choices in one sector (e.g. housing) can have a large unintended consequence in another (e.g. poverty). There is often no right solution because choosing between different outcomes require us to make compromises that are influenced by judgements of how we see the world. This means that to assess the true health benefits (and costs) of any policy we need to better understand what impact that policy might have on other domains. For example, will an education policy later impact on employment outcomes, or how might an environmental policy influence health. As no one policymaker has knowledge of the whole system and future economic and political developments are uncertain, SIPHER hopes to create models to predict some of these interdependencies to support healthy public policy development.
SIPHER will use complex systems modelling underpinned by the best available data and prior research in four different policy areas (see below). Our new evidence about likely policy effects across a wide range of outcomes will help decision-makers to pick between alternative policies depending on how important different outcomes are to them (e.g. do they want to improve health or boost economic growth?). We will develop support tools that can visualise these forecasts, identify policies that achieve the desired balance between competing outcomes and update recommendations when new information emerges. This approach is new to public health policy-making.
Whilst new to public health policy, these methods are well-established in engineering and climate science and therein lies the second feature that makes SIPHER different. In our team we have a large number of experts from different disciplines, such as Automatic Control and Systems Engineering where the kinds of methods we will use are regularly employed to understand, for example, how to make a car engine run more efficiently. In fact, among our team we have researchers from more than 10 disciplinary backgrounds who will be collaborating with our engineers to develop new public health models. The interdisciplinary nature of SIPHER will help us to develop the interplay between our detailed qualitative understanding of policy systems and the models that we will develop to quantify that understanding using existing data and the best scientific evidence available to us.
Thirdly, SIPHER is co-producing our research with policy organisations. Each step of our SIPHER process, from research design to policy implementation has been developed with our policy partners. And very little in SIPHER would be possible without our embedded researchers who are dedicated to SIPHER but employed by our Policy Partners. This means that we are truly embedded in the policy process and can use our SIPHER models and tools in real time to inform decision-making.
Combined, we believe these features of SIPHER make it a really exciting space to watch (and perhaps just a little daunting to be a part of!).
What is our policy focus?
Across our Policy Partners – Sheffield City Council, Greater Manchester Combined Authority (GMCA) and the Scottish Government – we are looking at four policy areas that are important to our Partners:
- Inclusive Economy (All 3)
- Housing (GMCA)
- Public Mental Health (Scottish Government)
- Adverse Childhood Experiences (Sheffield)
Our work initially is on Inclusive Economy and over the past 3 months our team has been busy generating baseline data and working to understand the Inclusive Economy landscape with key informants from each Policy Partner and the literature. This work provides a vital understanding of the policy system that will underpin the work of all of our other research strands. Expect some early results in summer 2020!
How can you learn more?
There are lots of ways to find out more about SIPHER. For a high level summary see our briefing paper or for a more detailed delve into our 8 work streams and our ambitions for the 5 years of the project see our Wellcome Open Research Letter. You can also explore our website or follow us on Twitter (@SipherC) or LinkedIn.