So, how do the manifestos stack up against these tests? An early spoiler: looking for a strategic approach to population health in the manifestos is like looking for needles in a haystack. While there are some policies that will impact on our health, there is far too much missing, and what is there is not brought together into a strong narrative or strategy that connects them, although the Liberal Democrats come closest.
First, a look at what appears as public health headlines in the ‘health’ bit of the manifestos. Labour’s focus is very much on children’s health, including a ‘new index of child health’, a £250 million ‘Children’s Health Fund’, more health visitors and school nurses, and a new child obesity strategy. It also commits to a tobacco plan. The Liberal Democrats say they will roll back public health budget cuts, and introduce a minimum unit price for alcohol (subject to the legal challenge in Scotland), a tobacco levy to contribute to health and care budgets and mandatory targets on sugar reduction. What few commitments the Conservatives make are focused on the NHS, eg, support for community pharmacy to help ‘keep people healthy’, though they will also extend Care Quality Commission inspections to local authority-commissioned public health services.
Second, what do the manifestos include about inequalities in health? The Conservative manifesto, recognises that ‘If you are born poor, you will die on average nine years earlier than others’ but there is nothing explicit on what the Conservatives would do to tackle the connection between disadvantage and health outcomes (with the exception of improving the oral health of deprived children). And there is not much on this topic in the Labour or Liberal Democrat manifestos either. As a whole, it seems that the parties, have either given up on explicit policies that tackle social inequalities in health, or assume that the wider polices in their manifestos will automatically tackle them.
So, third, what about those wider policies such as housing, access to education and work that evidence tells us are so important to population health? The Liberal Democrats are the most direct of all the three main parties, saying they will, ‘Publish a National Wellbeing Strategy which puts better health and wellbeing for all at the heart of government policy’. They also commit to improving air quality (through a new Air Quality Plan, which they claim will prevent 40,000 deaths per year), to legalising cannabis and giving the Department of Heath control for drug policy. Labour also have a strong focus on making it easier and cheaper for people from poorer backgrounds to access education and commit to a new strategy to reduce child poverty. The Conservatives offer National Insurance ‘holidays’ for employers taking on specific groups (such as those with disabilities and people unemployed for over a year). All three parties offer welcome commitments on housing, including on increasing the amount of social housing and on insulating homes.
But let’s look at some omissions. Neither Labour nor the Liberal Democrats challenge the current government’s plans to end the public health grant to local government; an issue we are very concerned about. Labour say nothing about rolling back the public health funding cuts of the current government or to putting health at the heart of all government policies, despite its pledge on this in 2015. This is all the more surprising because the Welsh (Labour-controlled) government has just passed the Public Health Wales Bill, which commits to health impact assessment of all relevant government policies.
Overall, while the Conservative manifesto is the sparsest of all in terms of commitments on public health, none of the manifestos stand up to scrutiny on inequalities in health, or have anything really meaningful to say on the role of the NHS in population health, such as strengthening accountability through STPs. Neither do they offer a compelling vision for leveraging the power of people and communities in creating health.
Whoever wins on 8 June, we will continue to challenge and hold the new government to account for its actions on population health. We will want to see:
- a cross-government strategy on public health (including stronger roles for tax and regulation) and explicit policies on reducing inequalities in health
- protection of, and increases in, public health spending
- a much stronger accountability framework locally for population health (including within STPs) which must include a stronger expectation of the NHS in tackling the wider determinants of health and in the development of population health systems with its local partners
- a greater focus on maximising the contribution of individuals and communities to heath, as Derek Wanless argued for in his ‘fully engaged scenario’ back in 2002, recognising the role of volunteering, social movements and the voluntary and community sector.
If we get that, the election will have been worth calling.