The role of the NHS in tackling poverty and the wider determinants of health

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As well as setting out the NHS funding challenge, a welcome focus of NHS England’s five year forward view is the health system’s role in promoting healthy lifestyle change. But beyond this, there is a bigger opportunity still. Despite all the pressures, the NHS remains, and will continue to remain, a massive economic and social entity. Are we making the most of this enormous power?

This is the question the Joseph Rowntree Foundation asked us to address as part of a wide range of evidence reviews to inform its anti-poverty strategy. Carrying out the review allowed us to think more broadly about the role of the NHS and its contribution to the wider determinants of health, with a focus on poverty. Today, we publish our findings in full

If health policy researchers and commentators think about the NHS and poverty at all, it is usually in terms of how well the NHS is doing compared to other systems in protecting people with low incomes from incurring excessive charges for care. This is, of course, critical and the NHS continues to do exceptionally well compared to virtually all other health care systems given its core principles of broad tax-based funding and treatment largely free at the point of use, proportionate to need.

But, looking deeper, there are problems in accessing health care for groups more likely to be in, or at greater risk of, poverty. In the paper we explore three particular areas; namely, families with children with severe disabilities, certain types of care for black and minority ethnic groups, and the impact of long-term conditions on people of working age. We find the NHS could do more to help people in these groups which could reduce the risk of poverty. 

The focus of the paper takes us beyond the NHS’s role in treatment. Last year, the Department of Health’s revenue spending on the NHS in England was more than £106 billion, and the NHS employs more than 1.3 million staff. The NHS therefore has a massive, much under-valued and under-analysed, impact on poverty and wider economic wellbeing. For example, if we had to pay directly for NHS services, the UK’s level of income inequalities, already one of the widest in the developed world, would be 13 per cent wider than it already is.

The health service is also more important economically in those communities where there is more poverty – accounting for between 10.7 per cent and 15.7 per cent of value-added (a measure of economic activity) in the north east, twice as high in relative terms than in London. We don’t recognise it, but the NHS is actually a de facto part of economic, social and regional policy. It is therefore the most powerful policy lever there is over the wider determinants of health.

But none of this is part of the current policy debate on the NHS, including the NHS five year forward view, Public Health England’s supporting document, or Lord Darzi’s recent big review of London’s health. This is surprising, since the wider role of the NHS is discussed in Due North, the recent report commissioned by Public Health England on health inequalities in the north of England.

Our paper sets out why we think this debate is absent, looks at good practice that is emerging, and explores what needs to happen now to help and challenge the NHS to play its full role in contributing to the wider determinants of heath, as well as in supporting lifestyle change.


jacqui prior

Social work
Comment date
19 March 2021

For decades the social care system has awaited reform which ideally would see proper joint working with the NHS. Until that happens and basic principles such as proper pay for care staff, funding for care and joint recording the NHS will continue to work with one hand tied.

Paul Munim

Community Enterprise East London
Comment date
16 November 2014
The NHS can play an important role by simply referring people to access local community services which are freely provided by the voluntary and community sector. Our website is a free directory of local community organisations that people can locate through postcode search. Most NHS staff are not aware of the services that local community organisations can offer and by simply referring people to access local services the NHS can make an impact on poverty without spending substantial funds.

Paul Johnstone…

Comment date
12 November 2014
Thought-provoking, as ever. The NHS can influence health inequalities by providing equitable access to health care, directly influencing the social determinants of health through procurement and as an employer and as a champion and facilitator, influencing and supporting others. The Due North report does make a number of recommendations for the NHS to strengthen health equity, including use of the Social Value Act and action to reduce children’s exposure to poverty. Be assured that issues such as these are very much part of the policy debate for agencies in the north. Only last week, for example, we were discussing this at the tripartite meeting for NHS and local authority leaders in the north, organised by NHS England, Monitor and the NHS Trust Development Agency.

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