Governments should set aside 10% of health spending for preventive and public measures such as cycle lanes and anti-obesity strategies, a thinktank has said, warning that “political short-termism” over health is making the UK increasingly ill and unequal.
The report by the Tony Blair Institute argues that a centralised NHS model “almost entirely focused on treating sickness” rather than on wider objectives is not only harming people’s health but hampering the economy, with more than 2.5 million people out of the labour market because of long-term ailments.
The report emphasises the human cost as well, noting that the effect of diseases caused or exacerbated by lifestyle means UK life expectancy is stagnating, while men living in the London borough of Kensington and Chelsea can now expect to live 27 years longer than their peers in Blackpool, Lancashire.
Among measures recommended by the authors are means of encouraging increased everyday physical activity, including more cycle lanes and green spaces, and the use of incentives such as wrist-worn fitness trackers.
The report also stresses the need for interventionist policies, such as restrictions on advertising junk foods, subsidies for healthier options, and investment in sports and community spaces.
Policies of these kinds are too often blocked by “the problem of political short-termism and courage”, it says, as well as the reluctance of some politicians to intervene.
However, the report says, lack of action is not itself a neutral choice: “These types of public-health intervention are sometimes criticised as ‘nanny statist’ but this fails to consider the power that advertising and our local environment has on our ability to exercise healthy choices in the first place. Creating a level playing field is vital.”
This requires not just long-term thinking, but also a coherent approach, the authors said, castigating what they portrayed as the current situation of underfunding, scattergun strategies and a lack of leadership.
The public health system is “woefully underresourced”, the report argues, with a significant cut to funding since 2015, while governments have attempted 14 different obesity strategies since 1992, none of which appear to have been effective.
The report also criticises the lack of a national body for public health matters. With Public Health England disbanded in 2020, its successor organisation, the UK Health Security Agency, and the Office for Health Improvement and Disparities “remain underfunded, lack clear strategy and skills, and are at risk of being forgotten in the public consciousness”.
Along with a coherent central plan, the authors stressed the need for effective localism, with accountable regional bodies working to improve public health, rather than “the existing top-down and reactive approach of the NHS”.
Other proposals include the creation of an independent watchdog in the style of the Office for Budget Responsibility to monitor health, and to designate money used for longer-term public health outcomes as investment, freeing it from the restrictions of day-to-day health spending.
With poor health now “one of the most significant structural weaknesses of the UK economy”, doing nothing is not an option, the authors said: “Healthcare demands continue to increase while costs are spiralling as health takes up an ever higher proportion of public spending. At the same time, outcomes are deteriorating. So, we’re all paying more and more to achieve less and less.”
