For a nation with an unrivalled public health heritage, the reports do not make good reading. The second highest obesity level in Europe, a worrying life expectancy gap between areas only a postcode apart and, according to The Lancet medical journal, the British population is among the least active on Earth.
Their figures reveal that 63.3 per cent of adults failed to reach the 150 minutes of weekly exercise needed to maintain their health, a level that outstrips the United States and its towering rates of obesity.
Reforming zeal, exemplified by the great Victorians, made Britain a safer and healthier place from the first landmark Public Health Act in 1848 through sanitation, vaccination and constant advance but, The Lancet judged, we have fallen behind comparable countries in death rates and quality of life, largely due to failings in public health.
It is a bleak backdrop, but we are now on the threshold of changes that could return a golden era with the mandate for public health handed back from the NHS to local authorities for the first time in 40 years.
Local authorities believe they are best placed to connect with the public in a way the NHS struggled to do
The government has granted a ring-fenced £5.45 billion for health and wellbeing boards, controlled by 152 city and county councils in England, to tackle smoking, obesity, alcohol and sexual health over the next two years.
Local authorities believe they are best placed to connect with the public in a way the NHS struggled to do. Public Health England, the new body established under the controversial 2012 Health and Social Care Act to oversee our health, is optimistic it can generate change among a lethargic public and get messages that resonate with both the “worried well” and the “couldn’t care” demographics.
Professor Lindsey Davies, president of the UK Faculty of Public Health, says it’s appalling that in some deprived areas “too many people accept that they are going to die at 65, just because most people do where they live”. Current average life expectancy in the UK is 85 among men and 89 for women.
The Health Foundation, an independent charity focused on inspiring healthcare improvement, believes the changes provide a perfect opportunity for people to “wake up and listen to their own bodies”, and use what they hear to make better lifestyle choices and have greater dialogue with GPs and healthcare staff.
“No one knows your own health better than you do. However, there needs to be a shift in the patient-doctor dynamic. We need to lose the deferential ‘doctor knows best approach’ and move to a more collaborative consensus on what is best for each individual. Initially this way of working may take more time, but in the long run it will empower individuals to take ownership of their own health,” says Adrian Sieff, the foundation’s assistant director.
The foundation has funded several projects aimed at testing practical solutions that support people to make informed and considered decisions about their own care and treatment.
People need to be disabused of the notion that the health service will always come to their rescue
The financial facts of life are brutal and any change is overdue. The cost of treating patients with diabetes, mainly the preventable type-2 condition, is running at £8.8 billion a year and smokers drain another £2.7 billion from the NHS. Together they are responsible for more than 100,000 avoidable deaths each year and a litany of conditions from eye problems to limb amputations.
Duncan Selbie, Public Health England’s chief executive, says people need to be disabused of the notion that the health service will always come to their rescue. “There’s this belief that the NHS ‘will sort me out when I get ill’. Well, it won’t… it can’t,” he says.
A new dawn is needed and a crucial element will be a move towards the individual taking greater responsibility for their own health, while technology and lifestyle companies finesse health innovation so it is both an affordable and compelling support to the NHS.
Advances make it easier by the day to access digital support for lifestyle changes and to perform a range of sub-medical tasks, such as heart rate and blood pressure measurement, at home which frees up clinical staff.
Mobile phones are being developed that can check basic vital signs and provide crucial emergency contacts with the elderly to prolong their ability to live independently. Trials around the country have local authorities glowing with praise about its reduction of hospital admissions and the impetus for patients to take a more active role in managing their conditions.
Companies also have a role to play. Many, such as BT, invest heavily to ensure their workforce is not derailed by mental and physical issues, and new recruits will start to demand a suite of employment benefits that include healthy work environments and tailored health insurance plans.
Observers believe a more flexible demographic is emerging of people who are comfortable with technology playing an increasing role in sustaining healthy lifestyles.
Steve Bedser, chairman of the Local Government Association’s Community Wellbeing Board, believes health needs a transformation on the same scale as the Victorians cleaning up water supplies and inventing sewerage systems.
“It is that fundamental,” he says. “Our ingenious forefathers would have solved this problem and we have to challenge ourselves to do just that. We have an obesity epidemic, one in five of us smokes and the tobacco companies are still able to recruit teenagers to become the smokers of tomorrow. We have low levels of participation in physical activity, and worrying levels of misuse of alcohol and drugs.
“Tackling these issues isn’t going to be easy, but failing to do so will not just lead to poor quality of life for many millions of people, it will also cost the country billions in future medical and care costs.”
Mr Bedser, a councillor who represents a ward in Birmingham and is the city council’s cabinet member for health and wellbeing, says devolving of public health powers from the NHS to local authorities is an opportunity to establish a more “creative, imaginative and lateral-thinking” health service.
Authorities will need to understand their public, recognise the barriers that have prevented the message getting through and address the issues of costs, he adds.
Birmingham launched a “Be Active” programme providing free municipal gym access and was rewarded with 390,000 of its 1.1-million population signing up.
“It is a huge response and it is a start,” he says. “We need to do things quickly so that we can improve the quality and length of life. It is a good thing to do for our citizens, but it also makes financial sense to try to keep people living at home independently because they are fitter and healthier than having them in care homes or hospitals.”
Public health professionals will now work closely with housing, environment transport and education departments to take the message and resources closer to the people. It is up to them, and the public themselves, to take up the torch of the Victorian reformers and inspire 21st-century innovation which can guide the nation to a healthier future.
CASE STUDY
What the future holds
By far the biggest barrier to filling our hospitals with the latest technology is cost. But what if they were given a blank cheque to purchase any kit they wanted?
A new hospital being built in Doha, capital of gas and oil-rich Qatar, might hold the answer. Sidra Medical and Research Center is being funded through an endowment of $7.9 billion from the Qatar Foundation – a non-profit, government-supported fund that invests heavily in massive education, science and research projects – and is expected to be one of the most advanced health centres in the world.
Those behind the project say it will provide world-class medical education, biomedical research, and healthcare for women and children in a country where the population is growing rapidly. But it’s the technology that really catches the eye.
Sidra will be wireless, filmless and (almost) paperless. Palm scanners will be used for check-in, which should ensure fast admission, and patients will reportedly swallow microchips that will monitor their progress and link directly to the doctors’ tablet computers.
The luxury rooms will be fitted with smart beds, which aim to avoid problems, such as pressure ulcers and sleep apnoeas, by adjusting the bed automatically to fit the patient’s needs.
All doctors, 600 physicians and 2,000 nurses will carry wireless devices, including tablets, to keep track of their charges, and each room will also have computer terminals. Sidra’s total staff will be 5,000, working over eight floors, although there will also be conservatories and healing floors.
State-of-the-art robotics, computer-aided surgery and diagnostics, and 3D+ imaging will be installed, and the hospital will have a special data room, where analysts will aim to eliminate redundant processes and make their care decisions on the strength of information most hospitals can only dream of.
