While integrating care services is part of the journey to a transformed health system, it is not the destination. Efforts to integrate care have rarely encompassed the broader health of local populations and the impact of the wider determinants of health.
In light of this, we published a report earlier this year pushing for a stronger policy and practice focus on population health systems. The report aimed to challenge those involved in integrated care and public health to ‘join up the dots’ – to see integrated care as part of a broader shift towards an approach focused on improving population health.
More recently, we’ve shown that the wider determinants of health (a complex mix of factors including income, housing and employment, lifestyles and access to health care and other services) are important in understanding differences in life expectancy between communities. For example, our analysis of around 6,700 communities between 2006 and 2010 found that for every 10 per cent increase in older people’s employment deprivation, older people’s income deprivation and housing deprivation, life expectancy fell by a year, six months and two months respectively. We also found that ‘place’ – the area in which a person lives – can be an additional important factor in determining life expectancy, over and above the general relationships between wider determinants of health, lifestyle behaviours and demography.
More recently still, the global burden of disease study on the United Kingdom (authored by Public Health England and others) showed that while life expectancy in England on average has been growing faster than many other developed countries – partly due to the fact it has previously been lower than in other comparable countries – there remains significant inequality in life expectancy that is strongly patterned by deprivation. Moreover, the same study shows that in terms of morbidity, there has been little or no improvement since 1990 in how long people live with illness and disease.
So people are living longer but in poorer health – which neatly encapsulates the challenge for integrated care. Many people of working age, particularly from lower socio-economic groups now have multiple comorbidities. Although more of us than ever are likely to reach old age (partly thanks to falling smoking rates), integrated responses to health need to respond as, and before, they get there. And since multiple comorbidity develops much earlier in lower socio-economic groups, integrated responses will need to bring in different balances of medical, care and social models of health to match people’s circumstances.
Our approach to integrated care therefore needs to develop if we are to keep up with the changing needs of citizens and patients, and those who will be patients in the future. In short, the health and social care system needs to be better integrated with other public services and the communities they serve.
The major focus of our integrated care summit this year is on population health systems. Building on the international examples we showcased in our report, the summit will put more flesh on the bones with examples from the United Kingdom. During the summit we’ll be holding breakout sessions on commissioning, place-based approaches, community partnerships and integrated health and housing. We’ll also be asking whether devolution is a vehicle that could get us to population health systems. At the end of the day, we’ll be hearing from Alonzo Plough about the experience of the Robert Wood Johnson Foundation, and what we can learn from their mission to instil a ‘culture of health’ in the United States. We hope you can attend the event, or follow the discussions during the day on Twitter at #kfintegratedcare.