We need a comprehensive, integrated framework to address the nation’s health, with a series of short, medium, and long-term initiatives to deliver the necessary transformation. Some examples of such initiatives are set out below.
1. Envision, evolve, experiment
Given projections of demographics and the incidences of major lifestyle diseases, together with the impact of issues such as antimicrobial resistance and emerging technologies, what would be best achievable health service in 5-, 10-, and 20-years’ time? A diverse multi-disciplinary group of experts should be set up to define the purpose and vision of an integrated, cradle to grave health service having regard to affordability. What are the fundamental steps needed to get there? What are the risks?
Change will involve evolution and experimentation should be encouraged. For example, there could be pilot schemes to change the shape of GP surgeries to move from cure to prevention. Surgeries could have resident personal trainers, nutritionists, and counsellors to whom patients could be referred on-site. Doctors are higher cost and too busy to spend time on some of the fundamental lifestyle issues which require behavioural change. There is a huge potential to save drug costs and improve treatment by focusing the right level of expertise on prevention at the right time. (Also see encourage below)
Those responsible for change should establish more mutually beneficial partnerships and alliances across government, academia, and commerce. For example, it is disappointing to see on the National Obesity Forum website the quote “we would prefer to partner with Whitehall but that’s not an option: the Government thinks it’s doing too good a job to need time for partnerships”.
2. Educate
Make health a compulsory GCSE which could also act as a platform for more advanced studies. Going beyond PHSE/RSE it should cover subjects such as anatomy, physiology, psychology, and nutrition. The goal should be to help students understand how their minds and bodies work and the impact of the environment they are in. If we all understood how we are programmed to think and function as sophisticated relationship-driven animals, and the mismatches we face between our evolutionary design and the modern world, significant improvements in mental, physical, and social well-being could be achieved.
Great progress has been in providing better information on health matters (e.g. the “Better Health” initiative) and in embracing technology (e.g. “Couch to 5K”) but more could be done. All present guidance should be critically reviewed and updated. For example, leading experts now question the “Healthy Eating” guidance and its validity. National guidance needs to cut through misleading and contradictory sources of information. Similarly, the information on physical activity should also be reviewed. There is some good content, but it isn’t necessarily complete or logically structured. In general, guidance on the 5 or so drivers of a healthy lifestyle, (avoidance of toxins, management of stress, nutrition, physical activity, and sleep) should be packaged on a new standalone website using the latest communication techniques. Leveraging partnerships and alliances with those with common interests would also be sensible as today’s efforts are hampered by GOV.UK’s infrastructure which appears outdated when it’s compared to production standards and technology of other, often less credible, sources.
3. Encourage
In many cases health issues arise from behavioural, not information, gaps. For example, smokers know the dangers of smoking but continue to smoke.
Recognising the impact of socio-economic factors, health services could be positioned differently. Again, by way of a pilot, centres could be created where people would want to go because it helps them, gives them hope and may even be sociable. Health may only part of the equation as numerous services could be brought together in a mutually beneficial way: part health treatment, classes and advice, part employment /benefits assistance, part Citizens Advice Bureau, part coffee shop, part community centre etc. These centres could be part of a repurposed high street where the services, especially in more deprived areas, are positively repositioned away from the taint and fears of social stigma. Depending on how they are set up it would be worth considering leveraging the operating models of say Citizens Advice or the grants approach of Sport England. Another possibility would be linking-in with a re-imagined high street in conjunction with other local authority initiatives.
Where climate change has David Attenborough as its figurehead, there is no such unifying voice or force in health. It may be good to find one. However, even in the absence of one such figure it would seem sensible to create a national impetus to focus on health. Enlist business leaders, well known personalities, and others as health ambassadors, implementing initiatives in their business, delivering the messages, leading by example etc. As a condition of lottery funding why not require Olympians to devote time to health promoting activities?. It should also be possible to leverage the work undertaken by other organisations such as those of the Premier League clubs.
4. Enforce
Consideration should be given to setting up a group to co-ordinate different regulatory efforts to counter the most egregious manipulation through health claims and messaging by food manufacturers and retailers, technology companies, fitness and nutrition advisers, the media, and others. By way of example
• Why are there so many fitness devices and equipment which provide different (inaccurate?) readings for the same activity?
• Should there be stronger independent quality standards imposed on the providers of fitness and nutrition education? Today’s qualifications and their practise are variable to say the least.
• If we want to reduce the vast consumption of ultra-processed food, should there be food packaging coding in line with the NOVA system of food classification? Should processed food be taxed differently rather focusing simply on sugar tax?
The group need not be large, in relative terms, as it should once again build relationships with, and leverage the work of, others in the public and private sectors with common goals (Government agencies, Which? British Advertising Standards etc). The public should also be encouraged to raise issues to be followed-up.
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