Abstract

Chaired by Meg Hillier MP, chair of the Public Accounts Committee, the webinar featured Professor Sir Michael Marmot, Professor of Epidemiology at University College London, and director of the UCL Institute of Health Equity; Lord Gus O’Donnell, former cabinet secretary; Noel Sharpe, deputy chief executive, Bolton at Home; Dr Navina Evans, chief executive, East London NHS Foundation Trust; and Lord Nigel Crisp, independent crossbench member, House of Lords, and a former chief executive of the NHS in England.

Explaining the academic underpinning of the subject, Lord Crisp described it as the “social, environmental, economic and political determinants of health – the things that shape our health, from education and employment, to housing, politics and power”. But he added it’s also about creating the conditions for people to be healthy and helping them to be so. Health and wellbeing, he said, are about “life and freedom, being all that we can be, living life to the full; they’re about our relationships, how we live and what happens to us at work and school; and they’re about confidence and control and the quality of our lives”.

He introduced three major strategies that would help push this agenda forward: creating health; prevention and promotion; and service provision. And everyone has a role in supporting this movement.

Dr Navina Evans explained the story of the East London NHS Foundation Trust and how her team realised that it wasn’t sufficient to just respond to contractual agreements and performance targets. They realised that in respect of how the organisation ran its services, proper engagement with patients and carers would be key. She explained how they set up a board sub-committee of patients, which has equal status to some of the Trust’s other committees and holds Navina to account. This moved on to embedding a culture of continuous improvement, with staff feeling empowered, before evolving even further into a broader mission to improve the quality of life for all the people the trust serves in its communities. Key elements in delivering this mission are the importance of partnership, seeding power to citizens to direct the trust, and building from the bottom up.

Noel Sharpe then explained some of the additional services that Bolton at Home, a housing association, provides to improve the health and quality of life for its residents. She stressed that the organisation doesn’t have clinical input and is not there to prescribe and to fix, but it aims to create an environment where people can flourish. For example, supporting people to find work, helping them feed their children during the school holidays, or addressing issues around domestic abuse. Noel welcomed the fact that she had been invited to join the integrated care partnership in the area, which brings different parties together to address some of the social, economic and health inequalities in Bolton. She also highlighted her organisation’s Peer Navigators programme, which recruits people from housing estates to work part time in the community on identified themes – eg, the environment, food growing, or working with children in the community. She echoed Navina’s comments about making ‘local’ work and using community partners to help create health.

Arguing that the overarching role of government should be to improve the wellbeing of its citizens, Lord Gus O’Donnell said government needs to promote the good and prevent the bad. Relating this to the forthcoming government spending review, he suggested that this should be used to promote good jobs – jobs with good security and which make people feel worthwhile; support parenting; and focusing on child development in early years. Programmes that support such initiatives must be well resourced, he added. He went on to describe policies that focused on more doctors and more hospitals as “the wrong way round”, and highlighted the value of early prevention and health promotion in children, pointing to the work of economist Lord Richard Layard. And he suggested that government can do much on taxing unhealthy consumption, eg, on smoking and sugary food and drink, and intervene more on behavioural change towards healthier lives.

Finally, the leading guru on social determinants of health, Sir Michael Marmot, explained how austerity and related regressive spending cuts had contributed heavily to the reversal of improvements in life expectancy among certain poorer sections of UK society, and a widening of health inequalities. A distinguishing feature of COVID-19 has been the high mortality in black, Asian and minority ethnic (BAME) groups. Sir Michael explained how a senior government person was recently asked about this when on the BBC and replied that it was terrible and that BAME groups should wash their hands and practise social distancing. Sir Michael was also asked for his view and he replied: “We should deal with structural racism.” And when challenged on what we should do tomorrow, he repeated: “We should deal with structural racism tomorrow. Right now.”

Moving on to the ‘build back better’ recovery agenda, Sir Michael said he hopes his 10-year follow-up report on health inequalities, published last year, can contribute to this discussion. He picked up on the prospect of automation being the “next pandemic” and manifesting in big inequalities, and warned that the role of work must be redefined in this new era. But he is heartened by the actions of some governments, for example New Zealand, which has put “wellbeing at the heart of its economic strategy”. He concluded: “We need to bring the health equity agenda and the climate agenda together to build a healthier and more sustainable society.”