Prevention in its own right

By Jim McManus | 27 March 2019

Last year the Government published Prevention is better than cure: our vision to help you live well for longer which set out a high-level vision to ‘revolutionise the current approach to prevention, and includes a major focus on the role of primary and community care services in achieving this’.

Work is under way to produce a Green Paper this summer on prevention which will seek to be system-wide, identify how to reduce inequalities in health and outcomes, and improve the health and wellbeing of the population.

This is a potentially huge opportunity for local authorities, but only if we feed into this in the right way, with some joined-up messages.

The first task will be to put the NHS Long Term Plan into context. It is a plan for an NHS which has never been good at prevention, seeks to make some step changes and has some laudable ambitions. But that plan, and the NHS, cannot and will not deliver the step change we need in prevention to make our country healthy and resilient.

In other words, we need prevention in its own right, and not as a means of saving the NHS.

That means we need system-wide action with a coherent vision of how to build a society less reliant on services; healthier for longer, spending more years in disability-free life and resilient and coping across the life course. Local government comes into its own here.

For too long as a nation we have not settled on a prevention narrative which goes any substantial way beyond a narrow focus on individual lifestyles.

I can think of five prevention papers over my 30-year career that have failed to galvanise real systemic action around inequalities in health, despite saying they would, because for each one the easiest option – and the one least supported by evidence – has been to focus on lifestyles.

The lifestyle story – behaviour, diet and so on – is one of the smallest contributors to the prevention equation.

When you think that by some estimates, the lowest income families would need to spend around 75% of their total income to buy food entirely consistent with Department of Health healthy diet guidelines, you can see lifestyle is one small piece of the jigsaw.

Good education, sustainable transport, good employment, good housing, and life skills for people which help them to be and remain resilient are more important.

A joined-up vision of what a good childhood or old age would be, and the powers to deliver this, would be major contributors to a healthier society and a more financially sustainable public sector.

So what could local government do? It should take stock.

In Hertfordshire, we have undertaken a corporate assessment of what prevention work we do and identified where and how it sits with the evidence of effectiveness. This in itself is no mean feat because the evidence on prevention remains patchy. But there is much we are doing. Is your fire service running Prince’s Trust programmes? Then you are delivering outcomes the NHS cannot and should not expect to.

Are your leisure services working on social isolation, confidence and cohesion?

Build the narrative of what we need to see in a Green Paper which is meaningful, and don’t start with behaviour. Start with the wider determinants

The role of local authorities in shaping a healthy place is the ground on which good health or bad health for a population will be built.

The next task for councils is to systematically tell the narrative around why these contribute to prevention in a way which Government can hear.

Do you have young people who have struggled in school who have been trained by your programmes in employability and are now progressing to jobs and training roles? Then you have a young person who will be healthier than they would be and have life skills which will help them avoid mental ill health and joblessness in future.

We should be core to the prevention vision using this analysis and narrative. We want a strong coherent vision of building a healthier society, not a retrofitting of a bunch of things Government departments were already going to do.

To do that we need system-wide action, with local government at its core.

But local authorities have a significant interest in this Green Paper getting the tone right. Because if it does, we will have a strong role in delivering it and making it happen.

If it doesn’t we will end up with the same lack of joined-up, siloed and poorly-visioned policy choices that have dogged prevention policy for the last 40 years.

Jim McManus is director of public health for Hertfordshire CC and vice president of the Association of Directors of Public Health

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