The Covid-19 pandemic has put our health front and centre during 2020. The first wave in spring resulted in 60,000 more deaths in England and Wales over a three-month period than we would have expected if the pandemic had not happened. While many countries have been hit by the pandemic, not all countries have been impacted in the same way. Hungary, New Zealand and Poland, for example, saw very few excess deaths during the first wave, with Bulgaria actually seeing fewer deaths than would otherwise have been expected. The UK, along with Spain and Italy, have unfortunately been on the other end of the scale, seeing the largest increases in death rates. Much of the focus and discussion about why this might be has focused on how governments responded to the virus back in March, but the public’s health and the resilience of our NHS when the pandemic hit are vital components too.
We should shift from seeing illness as a cost to seeing health as an opportunity for prosperity
In our book, Whose Health Is It, Anyway?, Dame Sally Davies, former chief medical officer for England and I take a close look at the role health plays in our lives, and how that has changed over past decades. The conditions we are born into, work in, and learn in are often called the social determinants of health. Dame Sally and I argue that instead of being passive, and our collective health being pre-determined by our circumstances, we could work to modify these drivers.
The pandemic has shown how vulnerable our society, economy, and day-to-day lives are to our collective ill-health, while also exacerbating the unequal nature of how health – good and bad – is experienced. As we look to a time when the worst of the pandemic has past, should we not reposition health as an asset – to each of us as individuals, and collectively as a society?
We argue that we should shift from seeing illness as a cost to seeing health as our most untapped opportunity for prosperity and happiness in the 21st-century – an opportunity not just to live longer, but also better. To realise this would take some significant changes, but fundamentally would require us all to value health differently – for what it is, rather than just what it is not.
For the healthcare system this means not just treating us when we are ill, but establishing a health system that exports health into communities through keeping the millions of people who live with chronic diseases well at home without the need to go to hospital. This means extending the founding principles of the NHS to ensure we have i) a comprehensive illness serve that is always there for acute care when needed; ii) a new, true health service that manages our chronic conditions in the community, ensuring diseases do not define who we are, nor our day to day lives; iii) and a National Care System– ensuring dignity as we age through a system based on fairness.
Outside the healthcare system this would mean reimagining our environment so that each actor – both public and private – either plays their part in improving communities’ stock of health, or pays into a national Public Health Investment Fund. Back in 2018, Dame Sally and I recommended the development of a National Health Index (NHI), which would track the stock of health across the country, and monitor how this varies within regions too. The NHI will reveal the health needs of communities while the three new societal contracts proposed in the book will pave the way to addressing these needs and reducing inequalities, and an additional funding stream will make the whole thing possible.
The NHI would be a metric to stand alongside GDP as an indicator of our future prosperity as well as the wellbeing of our nation. To ensure our stock of health growths, we also propose a National Bank for Health that would track our stock of health and set the framework for “play or pay”. Each actor, private or public sector, must play their part in improving the health of their workforce or community and if not, pay a levy into the Public Health Investment Fund. This would be invested on a 25-year horizon. Done properly this could deliver a dividend to us all.
In the midst of the worst pandemic for a century, where our illness has had such huge impacts on our day to day lives, now is the time to rethink how we all value health and reposition it to build a brighter and fairer future for all. ν
Jonathan Pearson-Stuttard is a public health physician and epidemiologist at Imperial College London, vice-chair of the Royal Society for Public Health, and Head of Health Analytics at Lane, Clark & Peacock. His book Whose Health Is It, Anyway?, co-authored with Dame Sally Davies, is out now with Oxford University Press