It is not difficult to spot the health policy failures of the current government. The damaging handling of the junior doctors’ contract dispute, spiraling NHS trust deficits and the misguided Cancer Drugs Fund are examples of policy failures available for easy and justifiable critique. However, despite these temptations to build credibility in this key policy space, Labour must do more than oppose. Just as the Attlee government recognised the need for radical reform to protect and improve the health of the British people in the wake of the Second World War, so now Labour must re-discover its appetite for leading a ‘prevention revolution’ to combat the persistent and widening health inequities of the 21st century.
The public health movement and prevention policy begin with a recognition that the determinants of health and wellbeing extend beyond the quality of the healthcare system, encompassing ‘social determinants’ such as education, housing, the environment and access to sport. Preventing ill health and promoting healthy living is a key part of enabling people to lead longer, healthier and happier lives, and thus is thoroughly consistent with Labour party values of distributing power and opportunity more equitably in society – as is the recognition that these social determinants really matter and it is a responsibility of all of us to counter their negative impacts.
The disparity between the quality of the NHS and health of the British people was underlined in a recent Commonwealth Fund report which compared the performance of 11 developed nation healthcare systems on measures of effectiveness, efficiency and equity. The NHS ranked first overall and in 9 out of 12 categories of health system performance. However, on ‘healthy lives’ – the measure of the health of our population- we placed second from bottom, ahead only of the USA and nine places behind France in first. This ranking is rooted in the persistent health inequalities between the richest and poorest communities of Britain, and demands urgent and visionary action. Rebalancing health policy in favour of prevention and health promotion should therefore be a priority for Labour, and represents a golden opportunity for the party to combine traditional values of social justice with a high impact modern policy programme.
Labour long ago lost its reforming instinct on health policy and must rediscover it to reclaim its status as the party which improves the lives of British citizens. The 2007 smoking in public places legislation was an example of forward-looking, prevention-focused policy with immediate and massive impact, directly leading to reductions in hospital admissions for acute heart and lung disease. In contrast, the 2015 Labour manifesto on health was conservative, modestly advocating for higher spending on the NHS and ‘improvements’ in structural measures of system quality such as GP and nursing recruitment. While these calls are justified in light of underfunding of general practice and government cuts to nursing bursaries, such traditional supply-side tools of system improvement will not be enough to solve the converging challenges of rising demand, rising costs and an ageing population facing the NHS. Furthermore, such pledges are a political dead end for Labour, as they easily play into the Conservative narrative of the party’s ‘addiction’ to ‘higher taxes, more spending and higher borrowing’.
The Conservative government are failing spectacularly on prevention. Sport England report fewer children are playing sport than in 2009, and government spending reductions have led to cuts to local sport and leisure budgets in excess 40 per cent in parts of the country. Disparities in access to sport are also widening; at London 2012, over a third of Team GB medalists were privately educated, but this proportion is expected to rise at Rio 2016.
At the same time as shredding the Olympic legacy of sports participation, the Tories are cutting £200m from local government public health budgets, a move that King’s Fund has described as ‘the falsest of false economies’. Such policies will have massive adverse implications for the both the NHS and the health of future generations.
In response, Labour should advocate for a revolution in sports participation among school aged children. The shadow health team should explore policy options such as devolution of earmarked budgets to head teachers and local community sports leaders to expand access to sport and to ensure money is spent where it is most needed. This should be accompanied by a reintroduction of the two hours per week compulsory school sports target, and support for developing local expertise in the organisation of extra-curricular sport. Such initiatives would build healthy lifestyle habits among a generation of young people with massive future pay-off for the NHS, whilst salvaging the national Olympic legacy.
By resisting the temptation to organise health policy around limited and conservative reliance on traditional measures of success, Labour has an opportunity to reclaim its status as the reformers and improvers of the health and wellbeing of the British people, whilst rebuilding economic credibility. Prevention is a surer road to victory than cure, and by reimagining its approach to health policy for 2020 Labour can offer a 21st century policy programme which truly drives opportunities for better health into the hands of the many, not the few.
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James McGowan is a member of Progress.
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