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

  • 12 November 2014
  • 3-minute read

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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.