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How to move towards a preventive state: which political party will grasp the four big opportunities?


While it is tempting to see only doom and gloom ahead, there is actually a remarkably wide consensus emerging on what needs to be done to help an incoming government make commitments on prevention in health and related policy – and how to make these commitments work in practice. We have summarised these into four big areas of opportunity.  

As a general election approaches, everyone is rolling out their asks. For example, The King’s Fund has been pleased to support A Covenant for Health work on what a new government could do to shift the dial on population health, and Action on Smoking and Health (ASH), the Obesity Health Alliance (OHA) and the Alcohol Health Alliance (AHA) regarding what policy-makers need to do to deliver a cohesive approach to alcohol, tobacco, and unhealthy food and drink policy, including the action needed to protect public health policy from the vested interests of health-harming industries. 

What we have not seen in the run-up to any recent election, however, is a coherent consensus from beyond the usual health policy voices on the need for change, which areas to focus on and, crucially, how to ensure actions stick over time. However, this time around, you will find multiple think tanks and institutions, from centre left to centre right, essentially arguing for very similar things. This is striking and positive, if politicians are listening.   

First is the need for a cross-government approach that is not solely owned by the Department of Health and Social Care. The public’s health is driven by so much more than health and care services and is impacted by the actions of many government departments, so the approach to improving public health must also take this approach. As expected, we see this in the views of health bodies, but you could cut and paste it into any recent policy thinking, from Reform to the Centre for Progressive Policy, the Tony Blair Institute to the IPPR.  

'You will find multiple think tanks and institutions, from centre left to centre right, essentially arguing for very similar things. This is striking and positive, if politicians are listening.'

Second, success requires close attention to the mechanisms required to cement health as a real priority across government departments. Specific ideas range from a minister in cabinet, such as the Covenant for Health’s Chief Secretary for Population Health, to wider cross-government groups or committees, such as a cabinet committee (Tony Blair Institute) or a body modelled on the Climate Change Committee (IPPR). A strategy that does not include serious goal setting, monitoring and accountability, though, is destined to fail. A return to some form of target-setting for health inequalities is argued for in a report commissioned by the Health Foundation, but this needs to be supported by wider scrutiny and accountability mechanisms. The Office for Budget Responsibility (OBR), or an OBR-related watchdog as suggested by the Centre for Progressive Policy, are common suggestions. 

Third is adequate funding. For this we need to know how much is actually being spent, and reform funding and payment mechanisms. On the former, while the local government public health grant and spending is visible and transparent, that is just a beacon in a fragmented funding landscape for public health and prevention. Demos has called for a new category of public spending for prevention to be reported by the Treasury, arguing that this would create greater accountability and prevent funding constantly being raided, or at least making that visible if it happens, while IPPR has called for a devolved cross-government health creation fund to put right the under-investment in prevention. On mechanisms there are a range of ideas, such as ‘polluter pays’ harms levies (as proposed in the Khan review of tobacco), but all agree sustainable funding streams for prevention are needed.  

Fourth are connected themes around localism, devolution and an increasing role for, and recognition of the role of, communities. This isn’t new but again it is remarkable how much consensus there is, from Demos’s focus on a devolved, citizen-led Preventative State, to CPP’s ideas on what ICS trailblazers could look like with stronger preventive powers and community focus, the Centre for Local Economic Strategies work on devolution and health, in which ICS’s are rewarded for improving economic conditions in their areas, and Reform’s harnessing of community assets for health. These are also consistent and aligned with much recent thinking and ‘doing’ in the local government and NHS worlds, including New Local’s work on community power, and related ideas of what increasing the power of communities means in practice in relation to health and care services

A criticism of all of the above, of course, is that it will not survive the collision with economic reality post-election. Political will is required to start the shifts needed, and politicians can and should be bold – the public is far more on side than is commonly portrayed. This is the final critical piece of the jigsaw. The public actually gets the need for change, is supportive of it, and is far more interventionist than many politicians think. There are consistent majorities in favour of more interventionist health policy, partly built on stronger public understanding of what really drives their health, as polling by The Health Foundation and The Fairness Foundation respectively show. The policy window is opening for politicians who really want to make a difference to population health after the next election.