Barbara Reichwein, Programme Director (multiple long-term conditions), Guy's and St Thomas' Charity
Feb 12, 2020
What helps us live longer and healthier? This is a question that more and more organisations are asking, including ourselves.
This month sees the publication of The Health of the Nation - A Strategy for Healthier Longer Lives, a new strategy by the All Party Parliamentary Group (APPG) on Longevity. We were pleased to be asked to contribute our views as the national strategy was being developed, sharing what we’re learning about health inequalities and the social determinants of health through our work on urban health and specifically our programme on multiple-long term conditions. A publication like this is always a welcome step, particularly where it recognises the importance of the social determinants of health in addressing inequalities.
This is a big area for us and the work we do in inner-city London, where our practice is already pointing to key ways to unlock solutions. If this was easy, it would have been done already, so we think creative thinking is needed on the lenses that we take to answering this huge question. We like to take three complementary lenses when looking at it: place, people experiencing a complex condition, and the role of new and non-traditional partners.
We start from the premise that, for people to live healthy lives for as long as possible, we need to focus further upstream from healthcare into the systems that drive underlying health inequalities.
Like in the new strategy, we see the pivotal role place has to play. Our own approach is to explore in-depth how health issues play out in a place and use evidence, data and lived experience to help us act with precision. This combination is helping us identify where the most meaningful levers for change are. For example, through our work on childhood obesity we have found that the biggest opportunities for preventing ill health lie in changing the incentives for environment owners – for example, those who run supermarkets, food outlets or public spaces – rather than for the individuals who experience those environments. We would like to see more emphasis on practical ways to tackle wider determinants in place.
We also believe there is room for thinking and policy-making on longevity to address more explicitly how we avoid widening health inequalities. Looking at specific groups of people experiencing complex conditions can help with this.
This requires changing circumstances such as housing, employment and financial inclusion with a focus on those most susceptible to health risks. As part of our programme on multiple long-term conditions, we are exploring debt and money advice as an important prevention opportunity, especially for people at risk of physical as well as mental health conditions. Unless explicitly designed with inequalities front of mind, we find that regulatory efforts (such as to reduce smoking) can produce uneven patterns and fail to offer enough support to subgroups. For example, in Lambeth and Southwark, 19% of people without long-term conditions smoke, but 32.7% of people living with chronic pain do. This is why pragmatic ways beyond regulation are needed to tailor for impact on inequalities.
Our research also confirms that mental ill health can occur early in life, and that it should be on the list of top risks. In people's lived experience of ill health, the role of mental ill health cannot be overstated and the healthcare and social care sector will continue to struggle to support it, unless financial, social and physical circumstances cater to protecting mental health. We feel strategies around longevity and healthy lives could more strongly point to ways in which actors across the system can act on this obligation. The work of King's Health Partners in screening for, and treating, the 'Vital 5' (high blood pressure, obesity, smoking, alcohol and common mental health conditions) at all levels of healthcare is an insightful start here.
Finally, we see a great opportunity in existing and new actors playing wider and, at times, non-traditional roles. For the NHS, a big opportunity beyond its essential role as a provider of healthcare lies in delivering on the long-term goal of developing as anchor organisations in places and supporting inclusive local economies. For businesses, equal treatment and decent conditions for low-pay workers to alleviate health inequalities will be a significant contribution. For local governments, opportunities for 'health in all policies' are most powerful in housing, inclusive local economies, schools, and financial inclusion.
Ten years on from the Marmot review, there is still much more to do, and we are proud to trial and share promising ways to tackle health issues in the context of diverse, urban places.
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Programme Director: Barbara Reichwein
23 April, 2020
As a funder, our priority is to support our partners and the communities most affected by COVID-19. Our Portfolio Director, Louise Mousseau, sets out the actions we've taken to date and how we're adapting our work in response to a changing environment.
25 February, 2020
Our Programme Director for multiple long-term conditions, Barbara Reichwein, reflects on persisting health inequalities ten years on from the Marmot Review.