Population health will matter to this government for one very good reason. Poor population health costs the state and the national economy big time. It is a key barrier to economic development and labour productivity across what is now a crucial swathe of England in political terms. It is the main reason why people drop out of the workforce and many of those never come back in. The impact of early morbidity leads to a loss of social contribution and an expensive dependency on state services, not least the NHS itself.
Population health is an area that is ripe for further devolution. Over the last four years, Greater Manchester has shown how this can be done. We have moved NHS resources upstream into preventative programmes and we have ensured that wider public policy is focused on promoting better health. As a result, we have rapidly declining smoking rates, increased physical activity levels for children and adults, improved mental health access, stronger early years outcomes and more people with poor health getting back into work. And over that period, we have also delivered a cumulative surplus on NHS budgets of £440m.
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The emphasis is going to be on the state as enabler. The role of central and local government will be to create the conditions in which people have a better chance to make better choices and reap the rewards of doing so, where space is given for schools, businesses, sports clubs, faith organisations and many others to contribute. Think Parkrun, Daily Mile, Men in Sheds, This Girl Can or Place2Be. This will be a period where population health will be defined by a complex and dynamic network of digitally-enabled and socially motivated organisations and wider movements for change.
The key test of any population health policy or programme is whether it can reach those that need it most. In Greater Manchester, we have deliberately bent the shape of some of our programmes to target areas of relative deprivation. They are about making people an offer to get the help that will ultimately enable them to get on in life; public and private capital combining to create human capital. These models don’t come for free; they need significant and deliberate investment in the capacity of the community, voluntary and social enterprise sectors, but the dividend is real and sustained.
Finally, there are of course limits to this philosophy. If you are in poverty and without essential security, then however dense the local network of opportunities available to improve health, there may not be the ability to engage. The fundamental safety net has to be secure to create the conditions in which everyone has a chance to thrive. And that may turn out to be the biggest population health challenge over the next few years.