There's more to health and wellbeing than the NHS! Out cycling on the Folkestone to Hythe Coastpath last summer. Photo: Gareth Williams via Flickr (CC BY).
Health and wellbeing are at the heart of our Green future
3rd July 2015
The NHS is one of our greatest institutions and we must defend it to the hilt, writes Natalie Bennett. But to build the healthy society we all want and deserve, we need joined up policies across the policy spectrum, valuing human wellbeing above crude economic growth.
It's not just the NHS - to turn things around we also need the right policies on the economy, transport, housing, energy, education, food security, clean air, green cities, the living wage, to create a healthy society.
When I'm talking about the NHS I'm mostly addressing the dire impacts of the rush to privatisation that we've seen since the 2012 Health and Social Care Act.
Like the near-collapse of a renowned dermatological centre in Nottingham since its takeover by Circle, a company whose failure at Hinchingbrooke hospital and abandonment of the contract there doesn't seem to have stopped it getting further NHS contracts.
Or the impact of the same company taking over musculoskeletal services in Bedfordshire, destabilising the income of the local hospital, and threatening its A&E department.
Or often I'm talking about the dreadful failures of our mental health services, the fact that if you have a mental health condition there's only a 28% chance of getting treatment.
And the figures showing that the rate of privatisation of the NHS is 40% higher than the three previous years combined.
Or more positively, I'm talking about Green MP Caroline Lucas taking the lead in a cross-party effort to introduce an NHS Reinstatement Bill, a bill backed by the British Medical Association.
It would strip away the costly, destructive market mechanisms that have sent administrative costs soaring, and restore the founding principle of the NHS, that the profit motive has no place within it - public money should be spent on health care, not be shovelled into private pockets (or all too often straight into the nearest tax haven).
What can we do for the NHS?
But today I want to put that to one side and ask a different question about health. To adapt from John F Kennedy, I want to ask today, not what the NHS can do for us, but what we, as a society, as policymakers, as politicians, can do for the NHS?
For it's clear that even if we succeed in removing the blocking and reversing the takeover of our broadly efficient and fair, publicly owned and run NHS by the disastrous American privatised model, the NHS will come under increasing pressure, from an ageing population, from the rise of expensive medical technology, from our increasing levels of middle-aged and even younger disability and illness.
In short, I want to ask what we can do to create a healthy society. Of course there are reasons for doing that beyond saving money for the NHS. A healthier society is, sticking to the money side, going to be a more productive and prosperous society.
And turning to issues of humanity and decency, a society that doesn't make its members ill through its structures and practices, is surely preferable to one that does.
And yet we have here in Britain, in the world's sixth-richest economy, a society that's making many of its members ill. A society that's failing to provide clean air, failing to provide adequate housing, failing to provide a healthy diet, failing to provide safe jobs and decent benefits, failing to provide opportunities for exercise, failing to provide an education that prepares pupils for life.
The UK is failing its people - especially the most vulnerable
A society in short that's failing its people. And the majority of people it's failing fall into one group, the poorer and more disadvantaged people in society.
It's the children growing up in poverty who are likely to live in areas with the worst air quality, in overcrowded homes with the fewest opportunities to enjoy green spaces; the adults struggling to balance zero-hours, minimum wage jobs, with no guarantee of a steady income and facing the threat of loss of the family tax credit that now makes it all, just, hang together.
It's the pensioners in cold and damp, impossible-to-heat homes without viable public transport options that allow them to get out and about and shop for healthy, affordable food.
And we're seeing inequality growing, more people falling into this group, or fearing falling into it - and that's despite the fact that the brilliant book The Spirit Level - I note in this company, written by two health economists - demonstrated clearly that everyone, even the rich, is worse off in more unequal societies.
We must end the 'unhealthy society'
The unhealthy society is affecting everyone to some degree. The poor are bearing the worst of it but all of us in this room, everyone in the country, is affected to some degree. Two days ago I was in London at an event organised by the Evening Standard talking about London's air pollution crisis. An attendee tweeted me afterwards "I had no idea it was so bad!"
She was not alone. In the worst areas of London 8% of deaths are linked to air pollution. Around the country, that's 29,000 premature deaths each year. And children whose schools are near busy roads are seeing the development of their lungs affected - an impact that will last for life.
In the workplace: we need to acknowledge that some of the longest working hours in Europe (what are being increasingly acknowledged as long, low-productivity hours) are deeply unhealthy and destructive.
Whether it's the impact on diet - there's the fact exposed by the horsemeat scandal that we eat on average twice as many ready meals as the rest of Europe, or the impact on the structure of our cities - a recent study on the concreting-over of front gardens that's greying our cities and towns, making them more prone to heatwaves and simply less pleasant, said that "lack of time for maintenance" was an important factor in household decision-making.
Or simply exercise: 45% of men and 34% of women say they are restricted in getting active by work commitments. And add in the human and health cost of commuting long distances - whether in fume-soaked cars or crowded trains and buses, in part as a result of house prices and rents - and there's no doubt our employment arrangements are severely detrimental to our health.
Unhealthy Britain is costing us all dear
And our homes are deeply unhealthy. 19% of households are in fuel poverty - primarily because of poor structure and insulation - which is linked to one in five of our horrific excess winter deaths, and contributes to the development of the lifelong condition of asthma in children. A study by the Chief Medical Officer showed that investing £1 in keeping homes warm saved the NHS 42p in health costs.
And on our streets we've seen walking and cycling all too often actively discouraged. Cuts to public transport (particularly rural and local buses) and inactivity causes nearly 20% of cases of breast and colon cancer, and more than 10% of cases of coronary heart disease and type 2 diabetes. It costs the NHS almost £1 billion a year.
Except around the edges - anti-smoking programmes, gym memberships and healthy food vouchers on the NHS - there's little that the health service can do to influence any of these issues.
Indeed doctors and other health professionals often express their frustration at the fact they're being asked to provide medical solutions for social problems, because their local GP is often the only person people feel they can turn to for help.
So it's not just the NHS - to turn things around we also need the right policies on the economy, transport, housing, energy, education, food security, clean air, green cities, the living wage, to create the healthy society we all want and deserve.
Some measures will be expensive - others not
Not all of the changes towards a healthy society are big-ticket spending items. Here's a few suggestions:
- Introducing a 20mph speed limit everywhere people live, work and shop could make our streets far more pedestrian and community friendly, a place to stroll, to chat, to play.
- Strengthening the power of unions and giving workers proper access to redress for unreasonable treatment would help to cut unpaid overtime, reduce stress and improve safety in the workplace.
- Make the minimum wage a living wage (which would save the Treasury more than £2 billion a year), and ban zero-hours contracts.
- Introduce a law in England and Wales (it's already in place in Scotland) to make it an offence to try to stop a mother breastfeeding in public spaces - and provide more education and support for mothers and assistance for working mothers to continue breastfeeding. (Again this is an issue of equality, 32% of low-income mothers breastfeed as against 65% of middle-income mothers).
Some moves towards a healthy society of course do require spending. The simplest way overall to improve health would be to tackle poverty - ensure everyone can put healthy food on the table, keep an appropriately-sized, energy-efficient roof over their head, be free from the fear of penury.
That of course would mean reversing the disastrous policy of austerity that's seeking to make the poor, the disadvantaged and the young pay for the errors and fraud of the bankers.
But coming down to a more modular level, looking at measures that would improve the health of everyone, here's a few suggestions:
- Invest in walking and cycling infrastructure - and public transport that enables and encourages people to let the train or bus 'take the strain' (and probably involves at least some walking at each end).
- Implement statutory PSHE education in all schools - evidence shows this reduces childhood obesity, improves diets, reduces sexually transmitted diseases and unwanted pregnancies, and hospital admissions for self-harm.
- Implement an intensive programme of home insulation and energy efficiency to cut excess winter deaths particularly among the elderly, reduce asthma rates in the young - and create jobs and cut carbon emissions.
Joined up policies for health and wellbeing
These are - in one of the favourite terms of government these days - joined up policies. They fit together into the whole of a healthy society - a humane, decent society in which people can fulfil their potential and live the long healthy lives that public health measures and modern medicine have helped to make possible.
They're possible, but not yet being made as highly probable as they should be. Every government decision, every funding cut or decision should be weighed for its impact on the health of the nation - both its physical health and its mental health.
That means something the Green Party has long been talking about - moving away from GDP as a measure of national progress. We need to ensure that we work towards national wellbeing, not the coarse and often damaging measure of economic output.
To put that into practical, and topical terms, consider yesterday's Airport Commission report. It came down on the side of Heathrow, acknowledging the massive air pollution and noise pollution issues, but brushing them aside with a mixture of 'live with it' amelioration measures like insulation for homes and schools (because you don't want to walk outside or be able to play in the playground) and airy promises that 'something will come up' in technological terms.
Government policy that put a healthy society at its heart would never have come to the conclusion that Sir Davies did.
And that's without even referring to the conclusions last month of the Lancet Commission on Health and Climate Change, which said failure to tackle climate change - and expansion of Heathrow (and full use of the new facilities) would mean Britain exceeding its legally binding targets on greenhouse gas emissions - would be (in the words of the learned authors) "catastrophic" for human health.
But it turns out the opportunity is enormous - do many of the things that we need to do to create a healthier society, encourage active transport, clean up the air, insulate our homes, and also tackle climate change.
What are we waiting for?
Natalie Bennett is the leader of the Green Party of England & Wales.
This article is based on Natali's keynote speech at the Manchester Medical Society and University of Manchester's International Festival of Public Health UK yesterday, 2nd June 2015.
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