A vision for population health in England

Durka Dougall

Over the last 100 years we’ve got to acknowledge the fantastic achievements that have been made to improve health, but yet the evidence shows that health outcomes in many areas are still mediocre. There’s still a predominant focus on reactive response to poor health and missing out on so many opportunities to prevent and intervene much earlier. There’s a plethora of things that impact on individual and populations’ health.

One of those, yes, is healthcare systems and services, but when you ask the question, what is the thing that impacts on your own health, quite often it’s where I live, it’s my family, it’s my social circumstances, it’s my opportunities and my access to those and the choices that I make on a daily basis. So therefore, population health, and I know there are lots of different definitions used for the term, the one that we’re advocating is the health outcomes for a group of people in a defined population at a local, regional, national level but importantly not forgetting the inequalities and the need to address the inequalities, there needs to be focus on mental and physical health and social wellbeing.

There needs to be much stronger focus on prevention and addressing the wider determinants of health as well as quality provision and support when it’s needed and fundamentally it needs a partnership approach. It cannot be done by one part of that circle alone.

It feels that we’ve taken steps but now enters the next phase, to really bring about a focus on those partnerships to look at the populations that they serve, the needs of those groups and how best to work together to really improve health outcomes.

We’re calling for health outcomes and inequality reduction in England to be on par with the best in the world and we think that this is possible but it will require the efforts from all of us, and more, to really join forces in a consistent and coherent way, really focusing on population health at a local, national, regional level.

David Buck

What we’re trying to do is bring some form of helpful coherence to an awful lot of work that you have been doing, we’ve been part of in the last 5-10 years. What we think is important are two things; one is that the focus of health policy including our role, recognises there are three circles beyond the health and care system more and we’ll make more efforts in that regard, and critically for us all, is we have to pay more attention on the overlaps, between the different systems that we all inhabit and work with. On one level it’s that simple, but beyond that we are also saying to do that, that’s not easy. There are things and barriers in the way of us all working, trying to achieve that today.

So we also set out some, a phased plan for journey to support our vision, focus on three particular things. One is the resources and particularly the resources outside the formal health and care system with a balance between the resources between the different aspects of care including public health funding. We also talk about accountability. Who is accountable for that bit in the middle? That’s a really tough question locally, regionally and nationally but we have to be much clearer about the answer to that if we’re going to achieve the movement that we seek to see.

And thirdly, again a common theme for The King’s Fund, the system management. Who’s managing this in collaboration with patients and communities? We provide some of our own answers for that but recognise actually to answer those questions needs more work from us and more work from you.

But some of the things we do talk about and some of our panel may reflect on this, one we do think we need stronger binding national goals for population health and health inequalities than we currently do have. We also believe and call for a new national health inequalities policy. We also things to have flagged much clearer accountability for population health. We also obviously have something to say about funding, about the real value of public health funding cuts. The question for us now is what do we do next and for us, we want to partner more in this agenda with all of your and others to make it a reality.

Please do respond to it, let us know what you support, what you don’t because that will influence us next year as we take this forward.

Thank you very much for your time.