By Lucy Gavens
In September 2019, as the SIPHER Consortium officially launched, the Health Foundation published a report on the need for a whole-government approach to long-term investment in the nation’s health. Summarising extensive work by researchers, think tanks and governments across the world, this report resonated strongly with our understanding in SIPHER of the relationship between health and the economy. Namely:
- Health is fundamental for a strong economy;
- Health is created and protected by strong communities, good education, clean environments, and good jobs;
- Government departments need to work together to deliver a joined up approach to health (since the conditions for good health highlighted in (2) are dependent on the work of multiple government departments); and,
- Government needs to take an active lead in this work.
Examples of good practice
Examples of commitments to joinedup government with a view to enhancing health and well-being are evident around the world. For example, New Zealand’s Wellbeing Budget seeks to break down silos and support cross-government work to implement policies that: improve wellbeing; acknowledge future (as well as current) generations; and track progress via broader measures of success than GDP growth. Another example is the Wellbeing of Future Generations (Wales) Act 2015, which requires public bodies in Wales to consider the long-term impact of decisions, to work better with people, communities and each other, and to prevent persistent problems such as poverty, health inequalities and climate change. These kinds of government interventions create a mandate for joined up action (e.g. by strengthening responsibilities to work together) and provide leadership for prioritising wellbeing across the public sector. This is a positive step.
What more do we know?
Achieving greater coordination across different policy areas has been a long-standing ambition within the UK but, despite recurrent efforts by governments, reviews suggest policymaking struggles to break free from policy silos. Through our work with policy colleagues at local, regional and national government, we have identified some specific barriers to joined-up working across government departments in the UK, that SIPHER is aiming to help address.
There is often a lack of evidence on ‘best buys’ for policy investment, particularly in conditions of uncertainty. In practice, this can make it difficult to articulate and defend the case for taking upstream, equity orientated action to prevent downstream health crises. Furthermore, the complexity and interdependencies of systems linking upstream determinants to health outcomes (which may materialise many months or years later) can be difficult to navigate and therefore paralysing.
Making sure that relevant evidence exists and is available at the right time is also a challenge. Understanding policy cycles (and how they operate locally), how to best communicate relevant evidence to target policy audiences and making sure the evidence is as relevant as possible to the local population are all important for making an impact. And where policies are implemented, there is often limited monitoring of expected and unexpected effects of policies and other system changes to gather robust information to support the refinement, revision or dropping of policies.
Further challenges can be found in the work of SIPHER Co-Investigator Professor Kat Smith who has extensive research experience in policy change for issues relating to public health and inequalities. Kat highlighted key challenges in a 2014 article in Science and Social Policy.
For cross-cutting policy action a key challenge is that government organisations are usually sub-divided into smaller teams that each focus on different policy priorities and this can make crosscutting policy ideas that span multiple teams an elusive goal.
Smith also found barriers relating to the wider policy context, including a widespread perception among researchers, civil servants, policy advisors, journalists and others that there is a dearth of public interest in health inequalities and a general disdain for policies aimed at reducing other types of inequalities. Only 8 out of 112 interviewees claimed any public appetite for more egalitarian policies and no-one claimed there was much media or political appetite for such policies. Yet, it was unclear what these perceptions were based on or to what extent they align with actual public preferences. There is also very little lobbying from organisations and individuals seeking to reduce health inequalities (in contrast to the extensive lobbying that takes place from unhealthy commodity industries).
What are we doing to address these challenges in SIPHER?
In SIPHER our ambition is to develop a decision support tool that supports cross-sector decision making to reduce inequalities and improve health and wellbeing. To address some of the key challenges highlighted by our policy collaborators and previous research we are taking the following steps:
- Co-creating our work with policy partners. By working together to understand their decision-making context and processes we hope to deliver timely, targeted evidence to inform policy making.
- Incorporating public and policy maker preferences for trade-offs across health and non-health domains, and for inequality reduction, to inform understanding of the appetite for more egalitarian policies.
- Identifying and making it easier to navigate existing evidence to support inclusive economy policy decision-making.
- Enabling policy makers across government departments to explore best buys for policy investment through an interactive dashboard that draws on system dynamics and microsimulation modelling to predict the impact of changes in policy areas (e.g. quality of employment, reduced unemployment) on health and inequality outcomes.
- Tracking the impact of policy changes over time to understand both intended and unintended consequences, and to enable policy refinement as and when needed.
This work will support joined up decision-making across the inclusive economy agenda in Sheffield, Greater Manchester and Scotland. Over time, we hope to support other governments who have committed to developing an inclusive or wellbeing economy, such as Wales and New Zealand, through developing a strong evidence base for systems science in healthy public policy.