One of the biggest shifts in policy thinking of the 2020s has been an increased recognition among politicians and civil servants of the interconnections between public health and economic prosperity. The pandemic created the rare conditions in which public health sat alongside – and often above – economic growth as the nation’s top policy priority. While the pandemic slips into history, there remains an acute awareness of public health as an economic problem. In the UK, the number of workers inactive due to ill health at a 30-year high and unlike most developed countries, life expectancy is stalling nationally and going backwards in many places.
Enter “mission-driven government”, and a national drive to realise both “sustained economic growth” and “an NHS fit for the future”. The plans for economic growth cover a wide range of measures around investment, infrastructure, taxation, innovation, planning, immigration, devolution, industrial strategy, and the labour market. To improve public health, the government has plans for investment to stabilise acute care, a revitalisation of primary care, behavioural public health interventions (e.g. on smoking), and a focus on the wider determinants of health. The last of these entails health policy that improves the environments in which people live, including their houses, streets, and workplaces.
Realising growth through health policy
The government is now in the very early stages of exploring how these two agendas overlap. In July, the health secretary laid down a marker with a speech calling for his department to play a key role in boosting economic growth. Predictably, a key focus was on getting people back to work. This is an example of one of those useful spill-overs, where DHSC seeks to reduce waiting lists, the Department for Work and Pensions seeks to reduce economic inactivity, and economic benefits are thus likely to accrue. A healthy workforce will support a healthy economy.
More challenging are those areas where extra activity is needed to realise the complementarities between health and wealth. For example, a lot of work is needed to realise the full economic potential of the “NHS and social care’s role as local and regional anchor institutions”. Here, there is a broader agenda around place-based policymaking and the need to empower mayors on public health.
Realising public health through economic policy
While these approaches rightly seek to exploit the economic benefits of health policy, there is a glaring hole in the agenda. What’s missing is an acknowledgement that there are significant opportunities for the economic growth agenda to contribute positively to public health. And, without a spotlight on public health across government, there are risks that this same agenda might have negative health impacts.
"What’s missing is an acknowledgement that there are opportunities for the economic growth agenda to contribute positively to public health. And, without a spotlight on public health across government, this same agenda might have negative health impacts"
For example, in Labour’s pre-election plan for the automotive sector, the word "health" is only mentioned in relation to the health of batteries rather the health of people. There is no political recognition that motor traffic is a major public health issue, in terms of air pollution, noise pollution, inactivity, accidents, and mental health. Instead, the focus is entirely on the economic benefits of the automotive industry.
Another example is planning reform, which lies at the heart of the government’s growth plans. There is an overriding focus on the quantity rather than the quality of housing units, alongside proposed reforms to fast-track brownfield developments, and open green-belt development. There is no consideration of how these issues will impact health, despite a large and growing body of evidence showing the link between urban development and public health. It is not only the number of houses that matters, but where these houses are built and their design that will lead to improved public health.
Marrying value and good health
Given that public health is widely recognised as a foundational factor in economic growth, it makes little sense to pursue growth strategies that drive ill health. A long-term strategy would prioritise public health gains to support sustainable economic growth. In the absence of a radical overhaul to how we define prosperity, it will be necessary to find practical solutions. These come through impacting the many day-to-day decisions around economic development. Because these decisions are fragmented among a wide range of different actors, solutions will need to be useful and usable rather than simply mandated from the top.
It is here that the economic valuation of public health is crucial. There exist several models that quantify public health impacts of decisions in economic terms. These have the potential to inform healthier urban development. For example, the TRUUD research programme has been working in partnership with MHCLG to embed one such tool in MHCLG Appraisal Guidance. Reforms of this nature can filter through the system and ultimately impact billions of pounds of public investment.
If these approaches were scaled up and adopted, a package of different health valuation tools would be available for civil servants to use for a range of purposes. The overall effect would be to lift public health up the priority-list in a multitude of daily economic decisions. To realise this, it is necessary to champion those tools and models that quantify health impacts, and find innovative ways of ensuring they are deployed in funding decisions across the public and private sectors. In this way, we can ensure that we drive the co-benefits of health and economic development that will ultimately lead to better outcomes for both policy objectives.
Dr Jack Newman is a research fellow and Professor Sarah A Ayres is a professor of public policy and governance at the University of Bristol's School for Policy Studies. Dr Geoff Bates is a lecturer and deputy director of studies at the University of Bath's Institute for Policy Research