There are nearly four million people living with diabetes in the UK. One in four British adults is obese, while rates in children are also on the rise. Some 15 million people in England have long-term conditions.
These raw numbers paint a bleak picture of the country’s seemingly insurmountable healthcare challenges. That the UK came in at 23rd in a recent international health index suggests there is a lot of work still to be done to improve wellbeing on a large scale.
The politics surrounding healthcare funding and services certainly doesn’t help. The announcement of longer waits as a ‘trade-off’ for other improvements illustrates the continuing strain on the system, while the frequency of the accusations of the NHS being used as a “political football” is one indicator of how charged the healthcare debate has become.
In this context, if we are to make substantive improvements to the health of the UK’s population, we need to reduce demand, while creating more efficient and effective services with the resources we have available. At the same time, we can’t rely on technology or new drugs — on their own — to whisk away our ailments.
This is the main thrust of The Health of People, a new report from the Campaign for Social Science. It sets out a vision for the ways the social and behavioural sciences can help improve public health by developing strategies that cut down on costs and variations in healthcare delivery, while promoting healthier individual and group practices. It argues that changing people’s behaviours is at the very heart of achieving this goal, as it addresses many of the causes putting pressure on our healthcare services from the start.
Our over-reliance on ‘common sense’ approaches has led to repeated policy failures and an avoidable waste of resources at a time when we can afford neither. Think of mid-life health checks designed to identify the risk of certain conditions and intervene to reduce their likelihood. While it might seem obvious that this would promote health and save money, these checks were often ignored by patients. Why? Because they were not based on sound evidence and failed to account for the changes in behaviour needed to ensure uptake. All this to the tune of £450m.
And yet, initiatives like these or other seemingly minimally disruptive measures like small ‘nudges’ in people’s behaviours are favoured by politicians because they are seen as easy to implement and don’t require challenging pervasive structural inequalities. This false economy is one of the reasons why nearly 80 percent of health research focuses on biomedical innovations as opposed to prevention, health promotion or how health services are delivered.
The reality is that the chances of leading a long and healthy life are influenced by everything from educational attainment and holding down a good job, to securing a safe place to live and engaging in rewarding social interaction. It is social science insight that explains the interplay between these factors and their impact on people’s health outcomes. By understanding the economic costs and benefits of health interventions, the effectiveness of treatments and clinical procedures, and behaviours that need to change in patients, GPs and policymakers, the social sciences unmask the drivers of better health.
The social sciences are also key to improvements in the design of large-scale interventions and policies. They show that change needs to happen at multiple levels to produce the most effective outcomes. For example, England’s Comprehensive Tobacco Control Strategy combined changes to cigarette packaging and taxation, legislation for smoke-free public places, and support for those trying to quit. The focus was not just on targeting people’s individual habits, important as that is, but also on community and environmental factors that impact group behaviour over the long term. This is one of the reasons smoking rates in England have now fallen to their lowest on record.
While the potential of the social and behavioural sciences to improve health is not widely acknowledged by the general public, that these crucial insights are not more readily drawn upon does a disservice to our healthcare system. To really bring about widespread health improvements for as many people as possible, we need to move away from ‘common sense’ models that don’t actually work, while enabling practitioners to deliver the best evidence-based interventions informed by both medical and social science research. This needs to be accompanied by greater integration of the social sciences into national health policy, along with a long-term view of healthcare by policymakers that is immune to political whims.
Instituting these changes will be no easy task. But if we are serious about relieving pressures on the NHS and improving population health for the future, we must be willing to take on these challenges. With the Health of People, we have an invaluable roadmap for how to achieve these goals.