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To drive down rates of disease, we need to look beyond the NHS

The Major Conditions Strategy can only build a healthier society if it considers economic inequalities.

By David Buck

Last week the government published the first stage of its Major Conditions Strategy. The report sets out the government’s initial thinking on its approach to tackling the growing burden of ill health. Does it stack up?

There can be no denying the health of the nation is in bad shape. Whether looking at life expectancy, levels of chronic ill health, inequalities, mental health, or the drivers of poor health, such as obesity, England’s recent record is poor and often compares badly to our neighbours. Unless something changes, the Health Foundation has projected that 2.5 million more people in England will be living with major illness by 2040 than in 2019. The government’s Major Conditions Strategy correctly argues that this means we must do more to prevent and delay the development of major conditions, in particular the six that drive the majority of ill health and early death: cancers, cardiovascular disease (including stroke and diabetes), musculoskeletal disorders (such as arthritis), mental ill health, dementia and chronic respiratory disease.

The problem is that people are increasingly experiencing many of these conditions at the same time, and the median age at which this happens is dropping and is now below 60. This requires changes to the way the NHS responds to ill health, from delivering care and treatment in silos by condition, to a more holistic approach which has implications for how services are delivered and organised, and how staff are trained. There is therefore much to agree with, as the strategy sets out the case for change and is rightfully optimistic that there is much more that can be done to help people lead better lives through preventing, delaying and supporting people with major conditions.

But if you want to know what the government is actually going to do, beyond existing commitments, you will be disappointed and will have to wait for the final strategy, scheduled for early 2024. To really make a difference, the government needs to make some bigger strategic calls.

The report accepts that what has driven the increase in major conditions is primarily beyond the NHS’s control – it’s how we live our lives and the conditions in which we live them, including air quality, food, physical activity, tobacco, housing and job quality to name just a few. And the more deprived a community is, the worse these factors are, and the earlier and more severely people get major conditions.

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These policy domains sit across much of Whitehall and in other tiers of government and public service. How resources flow from Whitehall into local places is therefore important in realising improvements. Worryingly, this month the Institute for Fiscal Studies has shown that funding allocations for some key services are not as aligned with deprivation and need as they should be. Will the Major Conditions Strategy be brave enough to get into this debate? Or will it stay “in-lane” and focus on just what the NHS can do?

But of course, it’s not all about the resources, it’s also political choices. The government needs to respond to the logic of its own analysis, that changing the way the NHS does things is necessary, but not sufficient. All the evidence points to stronger government intervention on prevention as the big win for population health, including smarter regulation of the food, tobacco and alcohol industries, and tackling inequalities in economic conditions. If this government really wants to make a long-term difference to the trajectory of major conditions and provide better care for those that have them, it needs to be bold in the final months before the next general election. It needs to rediscover the appetite for change that led it to implement the successful soft drinks levy, for instance. Will the government be bold enough to implement in full its own independent review of smoking and progressively increase the legal smoking age, or perhaps follow Scotland by setting a minimum unit price of alcohol? We will find out early next year.

Whoever forms the next government after the likely 2024 general election will need to pick up this mantle if they want to alleviate an ever-growing burden of illness. The recent independent Covenant for Health report, produced by a panel of experts and led by Lord Filkin, provides a list of oven-ready policies that would deliver measurable progress on prevention, if backed by a resilient cross-party commitment to “build a healthier nation over a generation”. These recommendations include a sugar and salt reformulation of foods; funding for strengthening communities in the poorest and unhealthiest places; and an independent review of the Treasury’s policies and how they impact health. This is crucial given the number of people out of work due to ill health, and the Treasury must own the goal to reduce health risks rather than be a critical bystander.

[Also read: The Research Brief: The case for preventing rather than treating ill health]

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