Shared values, shared health, shared prosperity

This chapter looks at the relationship between commerce and health, some of the choices involved, and the impacts they have on total health. Public health specialists and policymakers have only recently begun to explore the complex relationship between commerce and health, what it has been in the past, what it is now, and importantly what it could look like as we re-build society post COVID-19. The role that work and employers play in our individual, family, and collective health, security, and prosperity has developed over time, and the dependence of companies on the health of their workforce, and their vulnerability when employees are ill, has changed too. The private sector can contribute to health in its immediate community, and nationally through the products it promotes, the working conditions for its employees, and the causes it supports.

So whose health is it? Time to value total health

This chapter reviews some of the key issues around total health and describes a multi-pronged approach that starts from a true understanding of the value of health to individuals and to society. We outline the entities and processes that could underpin a new total health system, one that could serve to take us into a happier and more prosperous future. Everything we value as humans depends on health. But as a society, we do not seem to place a value on health that is concomitant with what it means to us, as individuals and as part of a wider community. Our vulnerability to COVID-19 has taught us that health is our most untapped opportunity for prosperity and fairness in the 21st century. It has brought us together, and shown us the stark realities of living in an unequal society. Good health, total health, must be at the centre of our recovery.

The commercial drivers of health

This chapter explores how the food, alcohol, and tobacco industries serve as commercial drivers for ill health, and describes examples of legislation aimed at shifting the dial towards better outcomes for all. Companies, especially multinationals, influence our health in a number of ways, ranging from their effect on the physical environment to their influence on government policy and the marketing strategies they use to promote their products in search of profit. The increasing reach and power of multinationals across all industry sectors in recent years has led to an increase in the extent to which they shape our environments and health behaviours, and this relationship is only becoming more intertwined. Alongside governments and multinationals, ‘new power’—the combination of social movements, social media, and purpose—is already re-shaping the world around us, empowering citizens and giving us cause for optimism.

Does the healthcare system help or hinder our health?

This chapter examines the problems inherent in the healthcare system today, and explores what a health system that copes with illness and also helps us to live well for longer might look like. Whether the healthcare system helps or hinders our health may seem a silly question. After all, the NHS has been crucial in saving the lives of tens of thousands of people during the first wave of the COVID-19 pandemic; without it the death toll would have been many times higher. But is our healthcare system helping us to be and remain healthy in the long term? Despite the efforts of the health and care workforce, there were more than 60,000 excess deaths in England and Wales in the three months from March to May 2020. The NHS was not set up, nor was it resilient enough, to cope with normal care and COVID-19 together.

Is our health system ready for the future?

This chapter looks at how the National Health Service (NHS) and the UK health system as a whole are understood now, and some of the issues that must be addressed. It also explores how to envisage a future that, after the first wave of the COVID-19 pandemic, looks very different to what might have been predicted six months ago. The NHS is a source of deep pride to British citizens because of its founding principles—universal access to healthcare for all, free at the point of use. However, things have changed since the NHS was founded in 1948. Ageing populations present with more and more complex chronic health conditions, but the health and care services have not kept pace and continue to use a single-illness model. This does not work well for patients and is expensive for the payer.

Introduction

This chapter discusses why it is time to re-think how we value and address our health in a complex and interdependent world. As the final pages of this book were being drafted, the COVID-19 pandemic had already claimed the lives of hundreds of thousands of people around the world. At the time of writing, the first wave has receded in some countries and lockdowns begin to ease, livelihoods of whole nations have been left in the balance and economic and societal progress has been halted or even reversed. The dependency of the global economy upon the health of its citizens has been laid bare by COVID-19. The prosperity and happiness of communities and nations has been devastated by illness, and the fragility of society has been clearly revealed. Worse still, the glaring inequalities in lived experiences have translated into shocking differences in survival rates among different communities.

Are we healthy? It’s complicated

This chapter introduces the concept of ‘total health’, which includes physical, mental, and social health, and also the underlying drivers that influence them. In England, the Department of Health and Social Care spends more than 95% of its budget on the National Health Service, which could be better described as the National Illness Service because health tends to be defined as what it is not, rather than a holistic state of well-being; ill health is what gets attention. The World Health Organization (WHO) has a different perspective, and defines health as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. Total health captures the WHO definition and its wider ramifications. This chapter examines two aspects of total health: the issues inherent in how health is viewed today and the role societal inequalities play in damaging health and life chances.

The social drivers of health

This chapter flags some of the traditional social drivers of health and discusses several emerging ones. The conditions into which we are born set off a chain of complex, interlinked responses to the world around us that combine to influence our entire life course. These include housing conditions, schooling, the education levels of our parents, employment opportunities, and availability of healthcare. They are traditionally thought of as difficult to change or resist, but we think of them as drivers, things that can be changed if the will is there. Social drivers contribute to health inequalities. The most deprived groups experience the poorest health outcomes, with shorter life expectancy and more years of life lived in ill health, and this situation has worsened over the past few decades. The key challenge is how to address these drivers and the inequalities they cause in our ever-changing, fast-paced world.

The promise of technology

This chapter focuses on how technology can contribute by helping the healthcare system to do more with less, empowering individuals with chronic conditions to live well for longer, and providing the tools to make populations healthier in the 21st century. Healthcare owes much of its success to technology, from penicillin, aspirin, and blood transfusions to transplantation, monoclonal antibodies, genomics, modern imaging, and surgery. Today, emerging and digital technologies—the fourth industrial revolution—have the potential to transform health and care services, making it better and easier for staff and patients, but unfortunately health and healthcare are yet to participate fully in the digital era. Public services as a whole lag way behind other sectors, let alone their users, the public. To drive change, both users of healthcare and those working in it must demand better and play their part in making it happen.