The UK is the “sick man” of Europe again. On almost every health indicator – life expectancy, healthy life expectancy, obesity rates and healthcare capacity – we lag behind our peers. This week, ONS data reconfirmed the substantial impact this is having on our national prosperity. The number of people who cannot work primarily because of long-term illness reached yet another record, at nearly 2.6 million.
This backs up recent research by the IPPR Commission on Health and Prosperity (which I co-chair). By tracking people over time, it demonstrated how the onset of sickness had substantial consequences in the UK on economic participation, income, job satisfaction and productivity.
All of this speaks to an essential truth: sickness is not only a matter of life and death, but of livelihood and opportunity too. Indeed, recent analysis that I co-authored has found that being in good health is now a better predictor of future employment opportunities than education.
This is not the first time the UK has lagged behind on health outcomes and faced the associated economic harm. During the 19th-century Industrial Revolution and the 20th-century postwar period, Britain faced health crises that, like today’s, also undermined labour supply, economic participation and growth.
In both cases, leaders implemented bold new public health strategies. In the 1800s, we took unprecedented public health action: cleaner drinking water, improved sewage disposal and new workplace protections. In the 1940s, we created the NHS. Each, at the time, was justified on both health and economic grounds.
These are among our greatest modern policy achievements, and we continue to benefit from them now. And their efficacy is down to the way they changed everyone’s approach to meet the new epidemiological and demographic realities of the moment. Today, this is where we are failing. As a nation, we have yet to grasp the changing nature of our health needs in the 21st century, and to design policy interventions and public services to suit.
One new reality is particularly challenging: the fact we are living longer but in worse health. Gains in quantity of life have not been matched by increases in quality of life: meaning more people, including many more working-age people, are living with the economic consequences and reduced wellbeing of long-term, multiple and complicated health needs.
This is likely to get worse. The Health Foundation estimates that the number of people with a major illness (37%) will grow nine times faster than the working-age population (4%) between now and 2040. This level of sickness would force many more out of work, with the poorest being hit worst. Consequentially, that means a weaker labour market, less tax revenue, higher welfare and NHS spending, and the perpetuation of the UK’s low-growth, low-productivity status quo.
This fate can be avoided. Today, about four in 10 cancers, eight in 10 premature heart attacks and strokes and substantial proportions of depression and anxiety could be prevented. Others could be treated more effectively, or better managed.
We know where action is needed: better diets, more physical activity, less smoking and drinking, quality housing, good jobs, and healthcare as focused on prevention as it is on cure. And we know what works: from levies on unhealthy products to rigorous housing standards, flexibility and autonomous work, stop-smoking services and investment in local public health and community healthcare.
So why are we not taking a more comprehensive approach and crafting all policies, including health, that are genuinely fit for the 21st century?
The crux is this: we simply do not value health sufficiently. Politicians and policymakers have not understood that investing in health is investing in the economy and instead, too often see illness as a drain. This incentivises a focus on limiting expenditure on healthcare today, rather than investment in long-term health creation for tomorrow. We need a wholescale change in how government thinks about, and acts to improve, health.
I am encouraged that ideas for achieving this change are increasingly visible. Our commission recently proposed we learn from the climate-crisis agenda and set the health equivalent of a net-zero target – a long-term mission to make the UK the healthiest country in the world by the 2050s – across all of government. Similar ideas have been proposed by the Institute for Government and the Health Foundation, among others. We have consensus – now is the time for real ambition.
Better health is fundamental to achieving a fairer, more secure, and more prosperous UK. But we will not get there by bumbling along with the status quo. We must, like those before us, take a more courageous and broad approach – to meet the distinct health and economic challenges of the 21st century. Our lives, our livelihoods and our happiness depend on this.
Prof Dame Sally Davies is Master of Trinity College, Cambridge, former chief medical officer for England, author of Whose Health is It, Anyway? and co-chair of the Institute for Public Policy Research Commission on Health and Prosperity
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