Let’s talk about health…
Our law lead, John Coggon, highlights why TRUUD interventions for better, fairer health require us to look carefully at definitions of health and its determinants.
To get anywhere, we need to get beyond simplistic agreement that ‘health matters’
Health matters. On that, at least most people will agree.
But it doesn’t take long to find fundamental disagreements about what the term ‘health’ covers: is it, for instance, just the absence of medically-diagnosed disease, or some much broader concept of positive well-being? Even where agreement can be found on that, we find fundamental disagreement too on questions of prioritisation: on which health problems to address first, where choices have to be made between them. And even where agreement can be found on that, disagreements can arise on whose responsibility it is to address health problems: individuals, employers, businesses, community groups, government actors, and so on.
In short, scratch the surface even lightly and we see all sorts of challenges in relation to what health and health policy are about. And this, in turn, shows us that questions that governments are facing about health are not just technical, fiscal, or administrative ones: they demand an open conversation about what we value, how, and why. To assist with that, Daniel Black, Jenny Hatchard, and I have produced a document explaining some of the key ideas, tensions, and opportunities that are uncovered when we ask what health means.
And we need to get past separating the urgent and the important
It can often feel like urgent problems take undue priority over important ones. Immediacy creates its own imperatives. But these come at costs. In relation to health policy, this is reflected in a deeply damaging conundrum. It is because health matters that we, as a nation, are so committed to having a public healthcare service. Yet while there we reflect on the high value of health through targeted—and expensive—services, in public policy more widely we see health significantly de-valued, or even ignored.
For as long as policy discussions on health primarily or exclusively address healthcare services, we are focused too much on the urgent problems of responding to ill health, while simultaneously worsening the important and expensive but slower-burn problem of creating avoidable ill health. Government is right to attend to the urgent question of fixing the ‘broken’ health service. But any successes will be self-defeating without giving firm attention as well to fixing problems of ill health before they arise. Preventive measures seem less acute. But if—as is the case—we, as a society, believe that health matters, and that it matters such that we ought to ensure a system of healthcare available to all, then we ought also to be persuaded that prevention of ill health matters.
The time horizons here differ: necessarily, urgent, immediate problems are to be addressed straight away. But if we do not grasp tomorrow’s avoidable health problems today, they will generate and compound new, divisive, and more costly urgency that needlessly comes to face us.
And this in turn means looking to health as a value across government
This is all easily said. But it needs to feature with greater prominence. The new government in Westminster recognises the importance of devolved decision-making. It also recognises the importance of health, including measures to lessen the incidence of avoidable ill health across the country. But as long as prevention gets bracketed or placed at the end of the list, we are in the perverse situation of saying that health matters and that ill health needs to be addressed, while widely sidelining health as a value to help drive decision-making.
This is why projects such as TRUUD have been funded: in TRUUD’s case, to change how we approach the value of better, fairer health opportunities and outcomes within urban place-making. It is time for a change in cross-government thinking and policy-making. It is self-defeating to health policy not to see health feature across policy domains: a key consideration in policy generally should be avoiding the worsening emergence of urgent health problems that then end up as ones for healthcare services to respond to.
