‘Levelling up’ the NHS is only one part of the picture

The wider social determinants of health are vital to improve the UK’s life expectancy performance, argues health correspondent Shaun Lintern

Data from the Office for National Statistics this week suggested we are less well connected with each other as a society (iStock)

Aneurin Bevan once described the NHS as the “envy of the world” and in many respects it deserved such a grand description, being one of the boldest socially progressive policies to emerge from the ashes of the Second World War.

Its singular aim was to improve the health of the nation: in attempting to do so, while costing individuals nothing at the point of use, it has earned a special place in the nation’s heart.

But the health service is only one part of a complex set of interdependent societal factors that actually contribute to the entire health and wellbeing of our nation.

Academics and policymakers call these factors the “social determinants of health”, including the environment in which you’re born, grow up, live and die. Your education, economic wealth, employment prospects, social links and neighbourhood are just some of the factors that contribute to your health.

For decades, the UK was doing well, with life expectancy rising by five years for men and four years for women between the early 1990s and 2010. By 2017, however, we knew something had stalled decades of progress.

Now a new report by the Longevity Science Panel has found that the UK was one of the worst out of 16 countries for mortality-rate improvements. The panel looked at the evidence of what could lie behind this and concluded that the spike in flu cases in 2015 and the government’s austerity agenda since 2010 are likely reasons for the poor performance.

In effect, what this means is that the wider social determinants of health for some sections of society – notably women – went into decline, with the consequence that more people died earlier than they would previously have been expected to on a stastistical basis.

The NHS endured its own version of austerity, not quite being cut but surviving on subsistence funding until 2018. The effects of poor investment in the “envy of the world” health service were laid bare in 2017 in a report by the Nuffield Trust and the Health Foundation, which found that the NHS did worse than average on eight out of the 12 most common causes of death, including heart attacks and all major cancers.

The UK has had consistently poor infant-mortality rates compared with other countries, and the 2018 report showed that the NHS had fewer beds, lower numbers of CT and MRI scanners, and less funding overall per head than most G7 nations.

Under former prime minister Theresa May, the government pledged £20bn to the NHS over five years as part of a long-term plan to boost the health service. That plan, published just over a year ago, set out to improve on key clinical priorities including cancer, cardiovascular disease, maternity and neonatal health, and mental health. The aim is to tackle the areas where the UK scores poorly.

The current prime minister, Boris Johnson, has made the NHS a priority and is determined, he says, to “level up” the country.

The latest report on life-expectancy performance is a reminder that throwing billions of pounds at the NHS addresses only one of the major determinants of health.

Data from the Office for National Statistics this week showed that we are less well connected with each other as a society. The Home Office’s latest immigration policy completely ignores the crisis in social care and threatens to make it worse as a result.

These are all social determinants of health that contribute to our wider wellbeing and chances of living a long, happy life.

To really deliver sustained improvements in life expectancy, and to stand a chance of catching up with other European countries, the government must consider those wider factors.