Many people in England are unhealthy and their health is getting worse. A healthy economy requires a healthy population. Whether looking at life expectancy, levels of long-term ill health, inequalities, mental health or the drivers of poor health (such as obesity), England performs poorly when compared to peer countries. Tackling the poor health of the nation is not the job of the NHS alone; there is a broad consensus that improving people’s health depends on a wider range of policies in areas such as housing, the environment and employment. If the next government wants to improve health and prevent people dying early, it should create an approach to improving health that spans all government departments, includes actions to reduce health inequalities, and implements measures that help people to make healthier choices.
What’s the problem?
- England’s population is getting less healthy. Life expectancy and health outcomes are lower in England than almost all comparable countries in Europe, as well as Canada, Australia and Japan. The assumption that children will live longer lives than their parents is now in doubt for some communities in England.
- Poor health is dragging down economic prospects for the country and for individuals and their families. More than half of the 3.3 million exits from paid employment in the five years before the Covid-19 pandemic were due to poor health. Loss of earnings from long-term sickness cost the UK economy £43 billion in 2021 – 2% of gross domestic product (GDP).
- Obesity, smoking, low physical activity and over-use of alcohol are the four largest preventable risk factors for major conditions such as cancers, cardiovascular disease (including stroke and diabetes), musculoskeletal disorders (such as arthritis), mental ill health, and chronic respiratory disease.
- In England, obesity rates are among the worst in western Europe. Around two-thirds of adults are above a healthy weight, and one in three children leave primary school overweight or living with obesity. The NHS spends around £6.5 billion a year on treating the consequences of obesity. Where the government has taken action to tackle risk factors there has been a positive impact – for example, the smoking ban in public places in 2007 and the soft drinks industry levy in 2015.
- Although health care services are important, there is now a wealth of evidence that wider determinants are the most critical drivers of health. In addition to income and wealth, these determinants include education, housing, transport and leisure. For example, poor housing conditions, such as exposure to dampness or mould, can lead to respiratory problems, allergies and other health issues.
- Avoidable differences in health exist and are growing between different socio-economic groups, different areas of England and people from different ethnic groups. People in the most deprived areas of England can expect to spend almost two decades less living in good health than those in the least deprived areas. These inequalities were exposed by the Covid-19 pandemic, during which death rates in the most deprived areas were more than double those in the least deprived areas. More than 250,000 excess hospitalisations are associated with inequalities in health in England – costing the NHS an estimated £5 billion per year.
- An unhealthy population weighs heavily on the economy and the Exchequer, whether in terms of higher treatment costs, increased welfare payments or people leaving employment due to ill health. Poor mental health, such as depression and anxiety, affects 1.35 million working-age adults who are economically inactive due to illness.
What can national government do?
Government can do this by:
taking a ‘health-in-all-policies’ approach to improving health and wellbeing
Some health outcomes are the result of the quality and availability of health and care services, but many others are driven by factors outside the health and care system. Health outcomes – how long we live for and how many of those years are lived in good health – cannot be improved by the Department of Health and Social Care alone. They require a cross-government approach nationally, and strong partnerships with local government, the voluntary, community and social enterprise (VCSE) sector, and the private sector.
Ensuring that all policies are considered for their impact on people’s health – from clean air to housing to active travel, and more besides – will help to ensure that people are healthier, able to contribute more to the economy and society, and reduce demand pressures on health and care services.
This cross-government approach should include action to reduce health inequalities, and measures to help people to make healthy choices.
Government can do this by:
taking cross-government action to reduce health inequalities
A health-in-all-policies approach will help drive improvements in people’s health overall, but it’s important that the benefit is felt by all communities. Government can reduce inequalities by taking focused action to ensure that the people experiencing the worst health outcomes see the greatest benefit. Such an approach should mobilise multiple sectors, including local authority teams and VCSE organisations, which often have more trusting relationships with communities experiencing the worst health outcomes.
A cross-government approach to reducing health inequalities has worked before. Between 1997 and 2010, government departments agreed cross-government commitments to work towards national health inequalities targets on life expectancy and infant mortality. By the end of that period, there was less of a relationship between how much money an individual earns and how long they live. Inequalities in life expectancy between local authorities covering the most deprived and least deprived areas narrowed, and there were reductions in inequalities in infant mortality.
The benefits of reducing health inequalities will be shared. For example, reducing health inequalities is good for HM Treasury, businesses and individuals as it can improve productivity through higher labour market participation rates, more working hours, and greater efficiency. Reducing health inequalities can also stimulate economic growth and raise incomes. Estimates suggest that the costs of health inequalities in health across European countries (including the UK) amount to more than 9% of GDP.
Government can do this by:
implementing policies, using tax and regulation, to encourage people to choose healthier diets and lifestyles – for example, by enacting the legislation that exists to restrict junk food advertising and supermarket promotions aimed at children.
National government uniquely has the power to take action to protect consumers who are being actively encouraged to make unhealthy choices. In the past, these measures have been used to reduce rates of smoking, for example with the smoking ban in enclosed spaces in 2007, as well as the Prime Ministers' recent announcement to create a smoke-free generation, but there are wider opportunities to do this in areas relating to alcohol, food and transport.
Government should make a quick start by implementing legislation that already exists to reduce obesity. The government legislated to implement a 9.00pm watershed for advertising of less healthy food and drink on TV and restrictions on paid-for online advertising, but implementation has been delayed until October 2025. The government has also delayed plans to restrict promotions of unhealthy foods such as ‘buy one, get one free’ in shops and online until October 2025.
Most people support these public health measures. More than two-thirds (80%) of UK adults support the government banning advertising of unhealthy food to children on TV and online, and 81% say they would like to see promotions on fruit and vegetables, dairy, pasta and rice, rather than junk food. More broadly, according to the Health Foundation, a majority of the public view the state as playing a central part in addressing the main risks for ill health. Only 16% of people think that the government has the right policies in place to improve public health.